From the Guidelines
Contrast-enhanced CT scans should be performed in gallstone pancreatitis 72-96 hours after the onset of symptoms to assess the severity of the disease and potential complications, as recommended by the 2019 WSES guidelines 1. When managing gallstone pancreatitis, the initial evaluation typically involves ultrasound to determine the etiology of acute pancreatitis, which is crucial for guiding treatment and preventing recurrence 1. However, in cases where severe acute pancreatitis is suspected or confirmed, contrast-enhanced computed tomography (CE-CT) or magnetic resonance imaging (MRI) is necessary to assess the severity of the disease and potential complications, such as pancreatic necrosis, vascular complications, or fluid collections 1. The optimal timing for the first CE-CT assessment is critical, and it is recommended to wait 72-96 hours after the onset of symptoms to ensure accurate evaluation of pancreatic necrosis 1. Earlier scans may underestimate the extent of necrosis, which could lead to inappropriate management decisions. In clinical practice, the decision to perform a contrast-enhanced CT scan should be based on the patient's clinical presentation, including signs of severe disease, clinical deterioration, or complications, such as persistent pain, fever, rising inflammatory markers, organ failure, or suspicion of necrotizing pancreatitis, pseudocyst formation, or pancreatic abscess. It is essential to weigh the benefits of contrast-enhanced CT against the risks, particularly in patients with renal impairment, where the risk of contrast-induced nephropathy must be considered, and alternative imaging like MRI might be a suitable alternative 1.
From the Research
Contrast-Enhanced CT Scan in Gallstone Pancreatitis
- A contrast-enhanced CT scan is a valuable tool in the diagnosis and management of gallstone pancreatitis, as it can help identify the presence of gallstones, pancreatic enlargement, inflammation, and peripancreatic fluid 2, 3.
- In patients with mild acute gallstone pancreatitis, a contrast-enhanced CT scan can be used to confirm the diagnosis and assess the severity of the disease, as well as to identify any local complications that may contraindicate early surgery 3.
- The CT scan can also be used to detect gallbladder features such as pericholecystic increased attenuation of the liver parenchyma, enhancement of the gallbladder wall, and thickening of the gallbladder wall, which can be valuable clues for the diagnosis of gallstone-induced pancreatitis 4.
- However, the use of contrast-enhanced CT scans in gallstone pancreatitis should be guided by evidence-based imaging guidelines, which recommend imaging only when necessary and avoiding unnecessary imaging studies that may increase radiation exposure and healthcare costs 5.
Timing of Contrast-Enhanced CT Scan
- In patients with acute gallstone pancreatitis, a contrast-enhanced CT scan can be performed upon admission, after at least 24 hours from symptom onset, to confirm the diagnosis and assess the severity of the disease 3.
- The timing of the CT scan may vary depending on the clinical presentation and the severity of the disease, but it is generally recommended to perform the scan when the patient is clinically stable and able to undergo the procedure safely.
Alternative Imaging Modalities
- Other imaging modalities such as ultrasound, magnetic resonance cholangiopancreatography, and endoscopic ultrasound may also be used in the diagnosis and management of gallstone pancreatitis, depending on the clinical presentation and the availability of these modalities 6.