Hypovolemic shock complex: does the pancreatic perfusion increase or decrease at contrast-enhanced dynamic CT?

Objective: The purpose of this study is to evaluate contrast enhancement effects of the pancreas at dynamic computed tomography (CT) to clarify whether pancreatic perfusion increases or decreases in severe trauma patients with hypovolemic shock. Methods: A total of 90 patients with (n=30) and without (n=60) blunt trauma and hypovolemic shock who underwent dynamic CT for abdomen was included. The measurement of CT attenuation values of the pancreas in the early phase and the late phase was performed to compare the contrast enhancement effects between patients with and without hypovolemic shock. Results: The mean CT attenuation values of the pancreas in the early phase of dynamic CT in patients with hypovolemic shock [95.4 +/- 29.1 Hounsfield units (HU)] were significantly lower (P <.001) than those in non-hypovolemic patients (136.6 +/- 17.9 HU), indicating decreased pancreatic perfusion in patients with hypovolemic shock. The mean CT attenuation values of the pancreas in the late phase of dynamic CT in patients with hypovolemic shock (95.9 +/- 17.6 HU) were significantly higher (P <.026) than those in non-hypovolemic patients (87.2 +/- 9.0 HU), indicating delayed or prolonged pancreatic enhancement in patients with hypovolemic shock. Conclusions: Decreased pancreatic perfusion in the early phase and delayed pancreatic enhancement in the late phase of contrast-enhanced dynamic CT was a common finding in patients with hypovolemic shock. (C) 2014 Elsevier Inc. All rights reserved.