Significance of Collections Around Colon in Patients With Acute Necrotizing Pancreatitis
Condition: Acute Necrotizing Pancreatitis
MeSH terms: Pancreatitis; Pancreatitis, Acute Necrotizing
Study type: Observational [Patient Registry]

Summary: 
      Acute pancreatitis is an inflammatory process which causes a local and systemic inflammatory
      response syndrome (SIRS). Although the majority of patients have a mild disease course,
      around 20% will develop moderate or severe pancreatitis, with necrosis of the (peri)
      pancreatic tissue and/or multiple-organ failure. Previous studies have correlated colonic
      involvement as a prognostic marker in acute pancreatitis. It is well known that translocation
      of the colonic flora may significantly influence the clinical course of patients with acute
      pancreatitis. The correlation between collection(s) around colon in CT finding and clinical
      outcomes has not been studied in necrotizing pancreatitis. In current study, the
      investigators will do a prospective observational study correlating collection(s) around the
      colon and clinical course of patients in acute necrotizing pancreatitis.
    

Detailed description: 
      Introduction and rationale of the study:

      Acute pancreatitis is the leading gastrointestinal cause of hospitalization in the US, with
      270,000 admissions annually. Acute pancreatitis is an inflammatory process which causes a
      local and systemic inflammatory response syndrome (SIRS). Although the majority of patients
      have a mild disease course, around 20% will develop moderate or severe pancreatitis, with
      necrosis of the (peri) pancreatic tissue and/or multiple-organ failure About 5-10% of
      patients develop necrosis of the pancreatic parenchyma, the peripancreatic tissue or both. A
      collection containing variable amounts of both fluid and necrosis associated with necrotizing
      pancreatitis; the necrosis can involve the pancreatic parenchyma and/or the peri- pancreatic
      tissues. A mature, encapsulated collection of pancreatic and/or peri- pancreatic necrosis
      with well defined inflammatory wall is walled off necrosis (WON). It usually occurs >4 weeks
      after onset of necrotizing pancreatitis.

      Colonic involvement may predict disease severity and outcome. Clinical features may appear
      late in the course. Colonic complications occur in 1% patients with acute pancreatitis with
      6-40% occurring with necrotizing pancreatitis. Correlation between colonic wall thickening at
      CT and the clinical course has already been established in non-necrotizing pancreatitis.
      Colonic necrosis is an adverse prognostic factor in pancreatic necrosis. Extension of
      necrosis towards the transverse colon and the splenic flexure were seen most commonly
      observed.

      Previous studies have correlated colonic involvement as a prognostic marker in acute
      pancreatitis. It is well known that translocation of the colonic flora may significantly
      influence the clinical course of patients with acute pancreatitis. The correlation between
      collection(s) around colon in CT finding and clinical outcomes has not been studied in
      necrotizing pancreatitis.

      Work plan methodology:

      This will be a prospective, observational study, to be conducted in 20 bed ICU of department
      of Critical Care Medicine, Sanjay Gandhi Institute of Postgraduate and Medical Sciences,
      Lucknow.

      All adult (≥18 years) ICU patients who had acute necrotizing pancreatitis will be considered.
      Demographic and clinical characteristics of all ICU patients who fulfill inclusion criteria
      will be collected along with relevant laboratory tests done for patient management routinely.
      ICU prognostication scores, i.e., Acute Physiologic and Chronic Health Evaluation (APACHE) II
      score and Sequential Organ Failure Assessment (SOFA) score will also be recorded. The
      investigators will review all available computed tomography scans (CT Scans) of abdomen, from
      2nd week to 6th week of pancreatitis, which will be done as per treating clinicians during
      patient ICU stay.

      Collection around colon is classified as: 1. No pericolonic collection; 2. Less than 90
      degree encasement of colon; 3. In between 90-180 degree; 4. More than 180 degree encasement
      of colon. Other intra-abdominal collection will also be noted along with mesocolon.

      Clinical course will be followed till ICU discharge in terms of need for drain and surgery,
      intra-abdominal infection, and survival at discharge.

      Statistical analysis: Descriptive analysis will be done and data will be presented as mean or
      median.

      Intervention: None. Waiver of consent has been granted by the Institute Ethics Committee
      (IEC).
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        All adult (≥18 years) ICU patients who had acute necrotizing pancreatitis.
      
Keywords: Necrotizing Pancreatitis; Critically ill; Mortality