From the Guidelines
Peripancreatic haziness should be evaluated and managed with a contrast-enhanced CT scan as the preferred imaging modality to determine the underlying cause and extent of the condition, as recommended by the 2019 WSES guidelines for the management of severe acute pancreatitis 1. The evaluation of peripancreatic haziness involves a thorough assessment, including:
- Complete history and physical examination
- Laboratory tests, such as serum amylase, lipase, liver function tests, and inflammatory markers
- Imaging studies, with contrast-enhanced CT scan being the preferred modality, as it yields an early overall detection rate of 90% with close to 100% sensitivity after 4 days for pancreatic necrosis 1 The management of peripancreatic haziness depends on the underlying cause, with acute pancreatitis being the most common etiology. Treatment typically involves:
- Bowel rest
- Intravenous hydration with lactated Ringer's solution
- Pain control with opioid analgesics
- Nutritional support
- If biliary obstruction is present, ERCP may be necessary within 24-48 hours
- For infected pancreatic necrosis, antibiotics such as imipenem or meropenem are indicated, potentially followed by percutaneous drainage or surgical debridement The CT severity index, established by Balthazar et al. 1, is a useful tool in grading the severity of pancreatitis and predicting morbidity and mortality. Key considerations in the management of peripancreatic haziness include:
- Close monitoring of vital signs, urine output, and laboratory parameters
- Serial imaging to track disease progression
- Tissue diagnosis through EUS-guided FNA or core biopsy if malignancy is suspected The prognosis varies significantly based on the underlying cause, with inflammatory conditions generally having better outcomes than malignant ones when treated promptly.
From the Research
Evaluation of Peripancreatic Haziness
Peripancreatic haziness is a term used to describe the presence of fluid collections or inflammation in the tissues surrounding the pancreas, which can be a complication of acute pancreatitis. The evaluation of peripancreatic haziness typically involves imaging studies, such as computed tomography (CT) scans, to confirm the diagnosis and assess the severity of the condition.
Imaging Studies
- CT scans are commonly used to evaluate peripancreatic haziness, as they can provide detailed images of the pancreas and surrounding tissues 2.
- The Atlanta nomenclature is used to classify the severity of acute pancreatitis, with peripancreatic necrosis being a subtype of necrotizing pancreatitis 2.
- Other imaging studies, such as sonography and endoscopic retrograde cholangiopancreatography (ERCP), may also be used to evaluate acute pancreatitis and its complications 3.
Classification of Peripancreatic Collections
- Peripancreatic collections can be classified into different types, including acute peripancreatic fluid collections (APFCs), pseudocysts, and walled-off necrosis (WON) 2.
- The classification of peripancreatic collections is important for determining the appropriate treatment and management of the condition.
- Interobserver agreement studies have shown that the use of morphologic terms to describe peripancreatic collections can improve the accuracy of diagnosis and treatment 4.
Management of Peripancreatic Haziness
- The management of peripancreatic haziness typically involves supportive care, such as fluid replacement and pain management, as well as treatment of any underlying conditions that may be contributing to the condition.
- In some cases, antibiotic prophylaxis may be necessary to prevent infection, particularly in cases of necrotizing pancreatitis 5.
- The penetration of antibiotics into pancreatic and peripancreatic tissue is an important consideration in the management of peripancreatic haziness, with some antibiotics penetrating more effectively than others 5.