Features of Ultrasonographic Anatomy and Manifestations of Local Complications in Acute Necrotizing Pancreatitis

Relevance: Diagnosing pancreatic necrosis and its complications is challenging despite the widespread use of state-of-the-art highprecision imaging methods in routine practice. Objective: To determine topographic features of local complications of pancreatic necrosis using ultrasonography and their effect on the disease outcome. Materials and methods: We examined 92 patients (mean age, 42.8±4.6 years) with moderate and severe pancreatic necrosis. There were 4 types (models) of pancreatic necrosis according to the spread of local complications: central, 25 cases (27.2%); left, 32 (34.8%); right, 16 (17.4%), and mixed, 19 (20.6%). We used ultrasound machines: LOGIQe (GE HealthCare, USA), MyLab 70 (Esaote, Italy), Voluson S10 (GE HealthCare, USA), with convex and linear transducers (5.0 and 7.5 MHz). Analyses were conducted with Microsoft Excel 2017 (Microsoft Corp, USA) using mean values, 95% CI, the χ2 test, and the P value. Results: We determined a diagnostic ultrasonographic algorithm, topographic relationship of local complications and abdominal organs, and ways of inflammation and necrosis spread, and compared disease outcomes for different configurations of foci. Discussion: The most popular landmark was the parapancreatic fiber and omental bursa (93.4%); the least, the paranephrium (28.3%) (χ2=135.674; P <.001) Leakage along Gerota and Toldt fascias showed no differences between the left and right sides (χ2=0.028; P=.867 and χ2=0.001; P=.977). Among the isolated foci, “stripes” (41.4%) (χ2=26.561; P <.001), “ovals” (20.7%) (χ2=75.625; P <.001) ), and “drops” (17.2%) (χ2=47.207; P <.001) were more common findings than complex configurations (“horseshoes” and “butterflies”). Conclusions: The refined diagnosis of local complications of pancreatic necrosis, ultrasonographic manifestations, and syntopy enable to predict the effectiveness of ultrasonography-guided percutaneous drainage and choose an optimal surgical approach.