Effects of acute and chronic pancreatitis on the stomach patterns of radiographic involvement.

The radiographic gastric changes associated with acute and chronic pancreatitis are described. The pertinent literature is reviewed and forms of involvement previously not reported are illustrated and discussed. Intramural and perigastric permeation of extravasated pancreatic enzymes and the secondary inflammatory reaction that follows are responsible for the radiographic changes observed. Generalized rugal thickening and particularly a localized spiculated appearance to the posterior wall of the stomach are transitory findings seen in acute pancreatitis. Radiographic abnormalities associated with chronic pancreatitis include patterns mimicking linitis plastica, indurated and nondistensible rugae involving the proximal stomach and a severely distorted gastric configuration induced by perigastric adhesions. The recognition of these patterns of involvement helps in the radiographic diagnosis and avoids confusing or evasive interpretations.