Nealon et al reported a classification for pancreatic duct anatomy for a patient with a pancreatic pseudocyst following an episode of necrotizing pancreatitis. This correlates with outcome and success of percutaneous interventions. The authors are from the University of Texas Medical Branch in Galveston and the M.D. Anderson Medical Center in Houston.
Patient selection: necrotizing pancreatitis with pseudocyst
Pancreatic Duct
Duct Type
normal (or near normal)
I
stricture present without distal obstruction
II
stricture with distal obstruction (disconnected duct syndrome)
III
changes of chronic pancreatitis (distended with irregular walls)
IV
Relation of Pseudocyst to Pancreatic Duct
Duct Subtype
no connection exists between the two
a
connection exists between the two
b
final designation =
= CONCAT((duct type), (duct subtype))
The pancreatic duct anatomy seen during an episode of acute pancreatitis correlates with:
(1) course of the initial attack
(2) duration of critical care and the number of organ failures
(3) success of percutaneous drainage and requirement for operative debridement
(4) occurrence of persistent fistula after debridement
(5) late complications
Duct Type
Spontaneous Resolution Pseudocyst
Success in Percutaneous Drainage
Operative Debridement Required
I
87%
83%
39%
II
5%
49%
83%
III
0%
0%
85%
IV
3%
0%
NA
To read more or access our algorithms and calculators, please log in or register.
