Is Differentiation of Haemorrhagic from Oedematous Acute Pancreatitis of Clinical Importance?

Abstract

The presence of “prune juice” fluid in the peritoneal cavity predicts severe acute pancreatitis with a specificity of more than 80% and a sensitivity of about 60% [1]. This test is invasive, has the potential to cause visceral perforation and is not routinely used to formulate a prognosis in patients with acute pancreatitis. Nevertheless, if it is carefully performed, the risk of misadventure is small and with the possible exception of the APACHE II score [2, 3], it provides the best indication of an impending severe attack when the patient is admitted to hospital. However, since it remains to be proven that introduction of intensive therapy at the time of the development of prognostic indicators of a severe attack can influence outcome or attenuate severity, it is difficult — in our opinion — to justify the routine use of peritoneal lavage in patients with acute pancreatitis. We continue to use lavage in patients who have clinical evidence of a severe attack because it may show that the diagnosis of acute pancreatitis is erroneous [4].