IR Considerations in Pancreatitis

Acute pancreatitis is associated with multiple complications, and imaging plays a major role in diagnosing them. Fluid collections are the most common non-vascular complication observed in acute pancreatitis. Image-guided drainage is required when the fluid collection gets infected or causes significant discomfort to the patient. The retroperitoneal route is preferred for the drainage of peripancreatic collections, and it often requires CT guidance. Transperitoneal drainage is done for large fluid collections that reach up to the anterior abdominal wall. The step-up approach is used in patients with persisting collection, wherein the drainage catheter is sequentially upsized, and video-assisted retroperitoneal debridement is done if necessary. Pseudoaneurysm formation is the most common vascular complication associated with pancreatitis, with splenic artery and gastroduodenal artery being the most common sites. All pseudoaneurysms require treatment irrespective of size, and endovascular embolization is the standard of care.