Sandbox:pancreatic abscess: Difference between revisions
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Pancreatic abscess should be diagnosed early and treat promptly not only to reduce morbidity and mortality, but also it is important to differentiate from other pancreatic disesases such recurrent pancreatitis, pancreatic psuedocysts etc. as the undrained abscess carreies high risk of mortality.<ref name="pmid14012297">{{cite journal| author=ALTEMEIER WA, ALEXANDER JW| title=Pancreatic abscess. A study of 32 cases. | journal=Arch Surg | year= 1963 | volume= 87 | issue= | pages= 80-9 | pmid=14012297 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14012297 }} </ref> | Pancreatic abscess should be diagnosed early and treat promptly not only to reduce morbidity and mortality, but also it is important to differentiate from other pancreatic disesases such recurrent pancreatitis, pancreatic psuedocysts etc. as the undrained abscess carreies high risk of mortality.<ref name="pmid14012297">{{cite journal| author=ALTEMEIER WA, ALEXANDER JW| title=Pancreatic abscess. A study of 32 cases. | journal=Arch Surg | year= 1963 | volume= 87 | issue= | pages= 80-9 | pmid=14012297 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14012297 }} </ref> | ||
* Recurrent pancreatitis | * Recurrent pancreatitis | ||
'''Pancreatic necrosis''' | |||
CT findings: Well marginated zones of non-enhanced pancreatic parenchyma | |||
'''Pancreatic abscess''' | |||
CT findings: Absent or limited necrosis | |||
'''Infected pseudocyst''' | |||
==Risk Factors== | ==Risk Factors== | ||
* History of alcoholic pancreatitis who fails to respond to medical therapy<ref name="pmid7137463">{{cite journal| author=Aranha GV, Prinz RA, Greenlee HB| title=Pancreatic abscess: an unresolved surgical problem. | journal=Am J Surg | year= 1982 | volume= 144 | issue= 5 | pages= 534-8 | pmid=7137463 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7137463 }} </ref><ref name="pmid4815930">{{cite journal| author=Miller TA, Lindenauer SM, Frey CF, Stanley JC| title=Proceedings: Pancreatic abscess. | journal=Arch Surg | year= 1974 | volume= 108 | issue= 4 | pages= 545-51 | pmid=4815930 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4815930 }} </ref> | * History of alcoholic pancreatitis who fails to respond to medical therapy<ref name="pmid7137463">{{cite journal| author=Aranha GV, Prinz RA, Greenlee HB| title=Pancreatic abscess: an unresolved surgical problem. | journal=Am J Surg | year= 1982 | volume= 144 | issue= 5 | pages= 534-8 | pmid=7137463 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7137463 }} </ref><ref name="pmid4815930">{{cite journal| author=Miller TA, Lindenauer SM, Frey CF, Stanley JC| title=Proceedings: Pancreatic abscess. | journal=Arch Surg | year= 1974 | volume= 108 | issue= 4 | pages= 545-51 | pmid=4815930 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4815930 }} </ref> | ||
Revision as of 18:33, 8 February 2017
Overview
Pancreatic abscess is an unusual and rare, but life threatening complication of acute pancreatitis.
Definition
Historical Perspective
Causes
Common Causes
Common organisms causing pancreatic abscess are as follows:[1]
Aerobic bacteria
- Enterococcus
- Escherichia coli
- Klebsiella pneumoniae
- Pseudomonas aeruginosa
- Staphylococcus aureus
Anaerobic bacteria
- Bacteriodes fragilis
- Clostridium perfringens
Differentiating Pancreatic Abscess from other Diseases
Pancreatic abscess should be diagnosed early and treat promptly not only to reduce morbidity and mortality, but also it is important to differentiate from other pancreatic disesases such recurrent pancreatitis, pancreatic psuedocysts etc. as the undrained abscess carreies high risk of mortality.[2]
- Recurrent pancreatitis
Pancreatic necrosis CT findings: Well marginated zones of non-enhanced pancreatic parenchyma Pancreatic abscess CT findings: Absent or limited necrosis Infected pseudocyst
Risk Factors
Natural History, Complications and Prognosis
Complications
- Intra abdominal sepsis
Gastric complications
- GI bleeding
- Gastric outlet obstruction
Colon complications Other complications
- Pancreatic fistula
- Pancreaticocolocutaneous fistula
- Wound infection
- Recurrent abdominal pain
- Duodenal fistula
Diagnosis
History and Symptoms
Common Symptoms
Presenting symptoms of pancreatic abscess are vague and variable, but common symptoms include:[1]
Less common symptoms
Vital signs
- High grade fever (greater than 37.8°C)
- Upper abdominal pain
- Failure to thrive
Physical Examination Findings
- Abdominal tenderness[1]
- Abdominal mass
- Abdominal distention
Lab Findings
- Leukocytosis (range between 10,500 to 35,00O/mm3)
Imaging
Imaging studies are crucial in the diagnosis and treatment of pancreatic abscess.
X-ray
- Shows extraluminal (pancreas or lesser sac) gas bubbles suggesting abscess[3]
Ultrasound
- Shows fluid filled sac suggesting abscess
References
- ↑ 1.0 1.1 1.2 1.3 Aranha GV, Prinz RA, Greenlee HB (1982). "Pancreatic abscess: an unresolved surgical problem". Am J Surg. 144 (5): 534–8. PMID 7137463.
- ↑ ALTEMEIER WA, ALEXANDER JW (1963). "Pancreatic abscess. A study of 32 cases". Arch Surg. 87: 80–9. PMID 14012297.
- ↑ 3.0 3.1 Miller TA, Lindenauer SM, Frey CF, Stanley JC (1974). "Proceedings: Pancreatic abscess". Arch Surg. 108 (4): 545–51. PMID 4815930.