Acute pancreatitis is an acute inflammatory condition of the pancreas characterized by sudden onset of abdominal pain, elevated pancreatic enzymes, and variable degrees of pancreatic inflammation. Its clinical presentation ranges from mild, self-limiting disease to severe pancreatitis associated with systemic inflammatory response, multiorgan failure, and significant mortality. Gallstones and alcohol consumption are among the most common causes, although hypertriglyceridemia, certain medications, trauma, and other factors may also contribute. Early diagnosis, accurate assessment of disease severity, and timely identification of complications are essential for appropriate management and improved patient outcomes.

The diagnosis of acute pancreatitis is generally established when at least two of the following three criteria are fulfilled: characteristic abdominal pain, serum amylase or lipase levels at least three times the upper limit of normal, and characteristic imaging findings. Although clinical evaluation and biochemical investigations are important, they may not adequately demonstrate the extent of pancreatic injury or associated complications. Imaging therefore plays a significant role in the comprehensive evaluation of affected patients.

Computed tomography (CT), particularly contrast-enhanced computed tomography (CECT), provides detailed anatomical visualization of the pancreas and surrounding structures. It helps identify pancreatic enlargement, inflammatory changes in peripancreatic fat, fluid collections, necrosis, and involvement of adjacent organs. CT also facilitates the assessment of disease severity and helps differentiate interstitial edematous pancreatitis from necrotizing pancreatitis.

Furthermore, CT is valuable in detecting local complications such as acute peripancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, walled-off necrosis, vascular thrombosis, hemorrhage, and associated infections. These findings can influence treatment decisions, including the need for intensive monitoring, drainage procedures, or surgical intervention. However, contrast-enhanced CT performed too early may underestimate pancreatic necrosis; therefore, its timing should be guided by clinical indications, particularly when severe disease or complications are suspected.

The present study aims to evaluate the role of computed tomography in the early diagnosis of acute pancreatitis and the identification of associated complications. It also seeks to assess the morphological changes and imaging features that contribute to disease severity assessment, thereby highlighting the importance of CT in clinical decision-making and patient management.

Study design: Hospital-based observational study. Study duration: One year, from January 2022 to December 2022. Sample size: A total of 50 patients diagnosed with or suspected of having acute pancreatitis were included in the study. Study setting: The study was conducted at a medical college and tertiary care hospital. Methodology: Patients presenting with clinical features suggestive of acute pancreatitis were evaluated through detailed history-taking, clinical examination, and relevant laboratory investigations, including serum amylase and lipase levels. Computed tomography (CT) of the abdomen, preferably contrast-enhanced CT wherever clinically indicated, was performed to assess pancreatic morphology and associated abnormalities. The CT findings were evaluated for pancreatic enlargement, altered parenchymal enhancement, peripancreatic fat stranding, fluid collections, pancreatic necrosis, and involvement of adjacent structures. Local complications, including pseudocysts, necrotic collections, vascular complications, and hemorrhage, were also documented. The severity of pancreatitis was assessed based on the extent of pancreatic and peripancreatic changes, with reference to established CT-based severity assessment criteria. Relevant clinical, biochemical, and radiological findings were recorded and analysed to determine the role of CT in the diagnosis and identification of complications of acute pancreatitis. Inclusion Criteria • Patients with clinical and biochemical features suggestive of acute pancreatitis. • Patients undergoing CT examination of the abdomen for evaluation of suspected acute pancreatitis or its complications. • Patients with adequate clinical and radiological records for analysis. Exclusion Criteria • Patients with chronic pancreatitis without evidence of an acute episode. • Patients with incomplete clinical or radiological records. • Patients in whom CT examination was contraindicated or diagnostic-quality imaging was unavailable. Statistical Analysis The collected data were compiled and analysed using appropriate statistical methods in Microsoft Excel and Epi-Info. Categorical variables were expressed as frequencies and percentages, while continuous variables were presented as mean and standard deviation wherever appropriate. The CT findings were correlated with the available clinical and biochemical parameters to evaluate the diagnostic role of CT in acute pancreatiti

The study comprised 50 patients diagnosed with acute pancreatitis, with a mean age of 42.52 ± 12.36 years. A considerable male predominance was observed, as 43 (86.0%) patients were males, whereas 7 (14.0%) were females. The male-to-female ratio was approximately 6.1:1, indicating a substantially higher representation of males in the study population

Table 1: Distribution of Patients with Acute Pancreatitis According to CT Grading

In our study, according to CT grading, the most common category was Grade C, observed in 22 (44%) patients, followed by Grade E in 15 (30%) patients and Grade D in 13 (26%) patients. No patients were classified as Grade A or Grade B. These findings indicate that all patients demonstrated CT changes corresponding to Grade C or higher, suggesting the presence of pancreatic or peripancreatic abnormalities in the study population. Grade C was the predominant category, while Grade E accounted for nearly one-third of the cases, indicating a considerable proportion of patients with more extensive CT abnormalities.

Table 2: CTSI Scoring and Deaths

In our study, mortality was observed across all categories of the Computed Tomography Severity Index (CTSI). Among the 50 patients, a total of 9 deaths (18%) were recorded. The highest number of deaths occurred in patients with a CTSI of 7–10, accounting for 6 cases (12% of the total study population). In comparison, 2 deaths (4%) were observed among patients with a CTSI of 4–6, while 1 death (2%) occurred in the CTSI 0–3 category. These findings indicate that mortality was more frequent among patients with higher CTSI scores, suggesting an association between greater radiological severity of acute pancreatitis and an increased risk of death.

Table 3: Complications

In our study, pseudocyst was absent in 40 (80%) patients, while 4 (8%) patients had pseudocysts measuring less than 6 cm in diameter and 6 (12%) had pseudocysts measuring greater than 6 cm. Pancreatic abscesses were observed in 3 (6%) patients. Regarding vascular complications, splenic vein thrombosis was the most common finding, occurring in 11 (22%) patients, followed by portal vein thrombosis in 2 (4%) patients and superior mesenteric vein thrombosis in 1 (2%) patient. Venous varices were observed in 3 (6%) patients, whereas no arterial complications were identified. These findings indicate that splenic vein thrombosis was the most frequent vascular complication in the study population, while pseudocysts larger than 6 cm were more common than smaller pseudocysts.

Acute pancreatitis is a potentially serious inflammatory condition in which imaging plays an important role in diagnosis, assessment of severity, detection of local complications, and prognostic evaluation. Computed tomography (CT), particularly contrast-enhanced computed tomography (CECT), provides detailed information regarding pancreatic morphology, peripancreatic inflammation, necrosis, and vascular involvement. Bharwani et al. [1] emphasized the importance of imaging in the diagnosis and management of acute pancreatitis, while Brizi et al. [13] highlighted the complementary role of imaging modalities in evaluating disease progression and complications. The findings of the present study further support the clinical utility of CT in assessing the morphological spectrum and complications of acute pancreatitis. In the present study, 50 patients with acute pancreatitis were evaluated, with a mean age of 42.52 ± 12.36 years. A marked male predominance was observed, with males constituting 86% of the study population and females accounting for 14%. This distribution indicates a higher representation of males among the patients evaluated. Chishty et al. [6] investigated the role of CT in acute pancreatitis across different age groups and demonstrated its usefulness in evaluating pancreatic abnormalities and associated complications. Differences in demographic characteristics between studies may reflect variations in patient selection, underlying aetiology, alcohol consumption patterns, and referral practices. In our study, CT grading revealed that Grade C was the most frequent category, accounting for 22 (44%) patients, followed by Grade E in 15 (30%) and Grade D in 13 (26%) patients. No patients were classified as Grade A or Grade B. Thus, all patients demonstrated imaging abnormalities corresponding to Grade C or higher. This distribution suggests that the study population predominantly comprised patients with appreciable pancreatic or peripancreatic inflammatory changes. According to the CT grading system described by Balthazar [9], progression from Grade A to Grade E reflects increasing morphological abnormalities, including pancreatic enlargement, peripancreatic inflammation, and fluid collections. Türkvatan et al. [3] described the characteristic CT manifestations of acute pancreatitis and emphasized the importance of identifying pancreatic and peripancreatic changes. Similarly, Bharwani et al. [1] discussed the contribution of imaging to disease assessment and clinical decision-making. The predominance of Grades C, D, and E in our study reinforces the importance of CT in documenting the morphological extent of acute pancreatitis. Nevertheless, morphological grading alone does not fully determine clinical severity, which must also be assessed using organ failure, systemic complications, and clinical parameters. In the present study, nine deaths were recorded among the 50 patients, giving an overall mortality of 18%. Of these, six deaths (12% of the total study population) occurred among patients with a CT Severity Index (CTSI) of 7–10, two (4%) among those with a CTSI of 4–6, and one (2%) among those with a CTSI of 0–3. The highest number of deaths was therefore observed in the group with the highest CTSI category. This pattern suggests that greater CT-assessed disease severity may be associated with an increased risk of mortality. Vriens et al. [4] evaluated the CTSI as an early prognostic tool in acute pancreatitis and highlighted its value in identifying patients at increased risk of adverse outcomes. Casas et al. [7] also examined the prognostic value of CT in the early assessment of acute pancreatitis, supporting its role in risk stratification. Similarly, Taydas et al. [5] investigated the accuracy of early CT findings in predicting the subsequent course of the disease. Clavien et al. [14], in a prospective study, evaluated the value of contrast-enhanced CT in the early diagnosis and prognosis of acute pancreatitis. The mortality distribution in our study is consistent with the concept that higher CTSI scores identify patients with more extensive pancreatic and peripancreatic abnormalities who may require closer monitoring and more intensive treatment. However, the figures presented represent the proportion of the entire study population dying in each CTSI category, rather than the mortality rate within each category. Therefore, category-specific mortality rates cannot be established without knowing the total number of patients in each CTSI group. Furthermore, the small sample size limits the ability to establish a statistically significant association between CTSI and mortality. In our study, pancreatic pseudocysts were absent in 40 (80%) patients. Pseudocysts measuring less than 6 cm were observed in four (8%) patients, while six (12%) had pseudocysts measuring more than 6 cm. Pancreatic abscesses were reported in three (6%) patients. These findings demonstrate that although pseudocysts were not present in the majority of patients, a proportion developed fluid collections or other local complications. Grassedonio et al. [2] described the role of CT and magnetic resonance imaging in evaluating local complications of acute pancreatitis, including fluid collections, necrotic collections, pseudocysts, and walled-off necrosis. Türkvatan et al. [3] also emphasized the importance of identifying these abnormalities and differentiating their imaging characteristics. CT provides information about the location, size, extent, and relationship of collections to adjacent structures, helping clinicians determine the need for observation, drainage, or other interventions. However, the interpretation of pancreatic collections should also consider their timing and internal characteristics, as not all collections represent pseudocysts. Under the revised Atlanta classification, a pseudocyst generally develops after interstitial edematous pancreatitis and has a well-defined wall, whereas collections associated with pancreatic necrosis require separate classification. These distinctions are important for accurate radiological reporting and appropriate clinical management. The findings of the present study demonstrate that CT provides valuable information regarding the morphological severity of acute pancreatitis, the presence of local complications, and the identification of patients with high CTSI scores. The observed concentration of deaths in the highest CTSI category supports the potential prognostic value of CT severity assessment. At the same time, the detection of pseudocysts, abscesses, venous thrombosis, and varices illustrates the importance of systematically evaluating both pancreatic parenchyma and adjacent vascular structures. Sharma et al. [8] examined clinical outcomes associated with early versus late CT in acute pancreatitis, highlighting the importance of appropriate imaging timing. Although CT is valuable in complicated or severe disease, routine early CT is not necessary in every patient with clinically established mild acute pancreatitis. Early imaging may underestimate pancreatic necrosis, and contrast-enhanced CT is generally most informative for assessing necrosis after approximately 72 hours from symptom onset when clinically indicated. Imaging timing should therefore be guided by diagnostic uncertainty, clinical deterioration, suspected complications, and failure to improve with initial treatment. Overall, our study supports the role of CT as an important diagnostic and prognostic tool in acute pancreatitis. Its ability to characterize pancreatic abnormalities, assess disease extent, detect local and vascular complications, and contribute to severity assessment makes it valuable in guiding clinical management. However, CT findings should always be interpreted alongside clinical examination, biochemical parameters, organ failure assessment, and the patient's subsequent clinical course.

Computed tomography plays a significant role in the evaluation of acute pancreatitis by identifying pancreatic morphological changes, assessing disease severity, and detecting local and vascular complications. In our study, Grade C was the most common CT grade, and splenic vein thrombosis was the most frequently observed vascular complication. Mortality was higher in absolute numbers among patients with elevated CTSI scores, suggesting the potential prognostic value of CT severity assessment. Overall, CT provides valuable information for clinical decision-making and management planning. However, its findings should be correlated with clinical and biochemical parameters, and imaging should be performed at an appropriate time to ensure accurate assessment of disease severity and complications.