The role of imaging evidence in pancreatic suppurations.

The authors wish to propose an interpretation protocol of the imaging dedicated to the pancreatic suppurations that appear in acute necrotising pancreatitis. Analyzing the data from the literature regarding the extension mode of the pancreatic suppurations, it promotes the idea according to which the surgeon must himself utilize and interpret the offered imaging. Using well known anatomical references, highlighted on the CT and MRI images and reconstructions, the surgeon is able to appreciate more accurately, on the basis of evidence, the references and limits of the suppurative collections. Thus, it is obtained a more precise topographic map of the suppurative areas and so it proposes the necessity of reporting to precisely named retroperitoneal spaces, that are part of the pararenal bilateral area. Hence it is identified the lumenal, parenchymal and vascular anatomical marks, which permit the exact anatomical reference of the retroperitoneal spaces interested by the pathological process. In this way, it creates the possibility of aimed surgical approach, with the selection of the ways of access towards the suppurative zones in order to avoid septic omissions. Finally, the authors propose the imaging reference to 13 retroperitoneal areas, areas that are contained under the name of pararenal space.