Revised Atlanta classification of acute pancreatitis

Dr René Pfleger et al.

The Revised Atlanta classification of acute pancreatitis (2012) is an international multidisciplinary classification of acute pancreatitis severity. It is an update of the 1991 Atlanta classification of acute pancreatitis.

The worldwide consensus aims for an internationally agreed-upon classification of acute pancreatitis severity, with standardized terminology for pancreatitis and its complications.

Classification

The classification system is based on both local and systemic determinants of severity, with:

  • local determinants related to the presence or absence of
    • (peri)pancreatic necrosis
      • sterile or infected
  • systemic determinants related to presence or absence of
    • organ failure
      • transient or persistent

The grade of severity (mild, moderate, severe, and critical) is based on combinations of these determinants.

Furthermore, a discrimination was made between two clinical phases of pancreatitis:

  • early (1st week): in which severity is based on the presence or absence of systemic organ failure
  • late (>1st week): in which severity is based on the presence of local complication or persistent systemic organ failure

Radiographic features

The Atlanta classification divides acute pancreatitis into:

All types of necrotising pancreatitis may be sterile or infected; gas formation is the best imaging feature to suggest infection.

Treatment decisions in the late phase rely heavily on morphologic criteria. The role of the radiologist is to aid in treatment planning by correctly addressing the morphologic changes.

A new terminology for fluid collections associated with acute pancreatitis is introduced 4,5:

ANCs and WONs are collections that contain both fluid and necrotic material of various amounts (an important point to differentiate them from APFCs and pseudocysts, however, in indeterminate cases follow-up is recommended).

The terms pancreatic abscess and intrapancreatic pseudocyst are totally abandoned in this new classification.

Pancreatic pathology
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Article information

rID: 28902
Synonyms or Alternate Spellings:
  • International multidisciplinary classification of acute pancreatitis severity

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Cases and figures

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    Case 1: interstitial pancreatitis with APFCs
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    Case 2: pancreatic pseudocysts, sequel of IEP
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    Case 3: pancreatic tail necrosis with ANCs
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    Case 4: necrotizing pancreatitis with ANCs
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    Case 6: infected intra and extrapancreatic WON
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    Case 7: necrotizing pancreatitis with WON
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