Early computerized tomography as a predictor of outcome in acute pancreatitis.

Fifty-one patients with the clinical diagnosis of acute pancreatitis were studied prospectively with early computerized tomography. It was found to be superior to ultrasonography for detecting acute pancreatitis and defining its extent. Grading of the initial computerized tomographic findings according to the extent of pancreatic inflammatory reaction identified patients with a high risk of local complications after onset of acute pancreatitis. Extension of the pancreatic inflammatory reaction into one or more peripancreatic areas with the simultaneous finding of pancreatic or extrapancreatic fluid collection or both was associated with a high frequency of pancreatic complications requiring surgical intervention and death. We believe that the severity of pancreatitis as shown by initial computerized tomographic scan is a more accurate predictor of clinical outcome than Ranson's criteria.