Sandbox:pancreatic abscess: Difference between revisions
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Revision as of 14:51, 13 February 2017
Overview
Pancreatic abscess is an unusual and rare, but life threatening complication of acute pancreatitis. It develop 5 weeks after the onset of pancreatitis and after onset of symptoms and subsidence of the acute phase of pancreatitis.[1] It is the most dangerous complication and the most common cause of death for acute pancreatitis.[2][3]
Definition
Historical Perspective
Causes
Common Causes
Common organisms causing pancreatic abscess are as follows:[4]
Aerobic bacteria
- Enterococcus
- Escherichia coli
- Klebsiella pneumoniae
- Pseudomonas aeruginosa
- Staphylococcus aureus
- Proteus
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.[5][6]
- Recurrent pancreatitis
Pancreatic necrosis CT findings: Well marginated zones of non-enhanced pancreatic parenchyma Pancreatic abscess CT findings: Absent or limited necrosis Infected pseudocyst
| Characteristics | Pancreatic abscess | Infected pancreatic pseudocyst | Infected necrotic pancreas | Recurrent pancreatitis |
|---|---|---|---|---|
| Definition | Pancreatic abscess is defined as a localized collection of pus surrounded by a more or less distinct capsula in inflamed pancreas. | Necrotic pancreas defined as a diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue, but without any significant pus collections | ||
| Presentation | Present after onset of symptoms and after subsidence of the acute phase of pancreatitls | clinically evident during the early phase of acute pancreatitis with signs of sepsis | ||
| Laboratory Findings | ||||
| Prognosis | Mortality is high compared to pancreatic abscess |
Epidemiology and Demographics
Prevalence
Incidence
Incidence of pancreatic abscess is unknown, but McClave et al reported it as 2-5% among patients hospitalized for pancreatitis.[7]
Case Fatality Rate
Mortality rate of pancreatic abscess is varies depending upon the severity of pancreatitis with range of 10-59%.[8]
Age
Gender
Race
Developed Countries
Developing Countries
Risk Factors
Natural History, Complications and Prognosis
Complications
- Intra abdominal sepsis
- Peritonitis
- Septicemia
- Renal failure
- Pleural effusion
- Bronchopneumonia
- Atelectasis
- Pulmonary embolus
- Hepatic failure
Gastric complications
- GI bleeding
- Gastric outlet obstruction
Colon complications
- Colonic fistula
Other complications
- Pancreatic fistula
- Pancreaticocolocutaneous fistula
- Wound infection
- Recurrent abdominal pain
- Duodenal fistula
Association
- Biliary tract disease
- Alcohol addiction
- Carcinoma
- Peptic ulcer
- Trauma
- Polyarteritis nodosa
Diagnosis
History and Symptoms
Common Symptoms
Presenting symptoms of pancreatic abscess are vague and variable, but common symptoms include:[4]
Less common symptoms
Vital signs
- High grade fever (greater than 37.8°C)
- Upper abdominal pain
- Failure to thrive
Physical Examination Findings
- Abdominal tenderness[4]
- 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[9]
- Disclosed pleural effusion[10]
- Diaphragmatic elevation
- Basilar atelectasis
Ultrasound
- Shows fluid filled sac suggesting abscess
Treatment
Surgical Therapy
Transpapillary Drainage
Endoscopic Drainage
Indications
- Patients who are unfit for surgical drainage.
Advantages
- Less invasive
- Potentially safe
References
- ↑ Bittner R, Block S, Büchler M, Beger HG (1987). "Pancreatic abscess and infected pancreatic necrosis. Different local septic complications in acute pancreatitis". Dig Dis Sci. 32 (10): 1082–7. PMID 3308374.
- ↑ Bolooki H, Jaffe B, Gliedman ML (1968). "Pancreatic abscesses and lesser omental sac collections". Surg Gynecol Obstet. 126 (6): 1301–8. PMID 5652669.
- ↑ Ranson JH, Balthazar E, Caccavale R, Cooper M (1985). "Computed tomography and the prediction of pancreatic abscess in acute pancreatitis". Ann Surg. 201 (5): 656–65. PMC 1250783. PMID 3994437.
- ↑ 4.0 4.1 4.2 4.3 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.
- ↑ Bittner R, Block S, Büchler M, Beger HG (1987). "Pancreatic abscess and infected pancreatic necrosis. Different local septic complications in acute pancreatitis". Dig Dis Sci. 32 (10): 1082–7. PMID 3308374.
- ↑ McClave SA, McAllister EW, Karl RC, Nord HJ (1986). "Pancreatic abscess: 10-year experience at the University of South Florida". Am J Gastroenterol. 81 (3): 180–4. PMID 3513543.
- ↑ Neoptolemos JP, Raraty M, Finch M, Sutton R (1998). "Acute pancreatitis: the substantial human and financial costs". Gut. 42 (6): 886–91. PMC 1727149. PMID 9691932.
- ↑ 9.0 9.1 Miller TA, Lindenauer SM, Frey CF, Stanley JC (1974). "Proceedings: Pancreatic abscess". Arch Surg. 108 (4): 545–51. PMID 4815930.
- ↑ Camer SJ, Tan EG, Warren KW, Braasch JW (1975). "Pancreatic abscess. A critical analysis of 113 cases". Am J Surg. 129 (4): 426–31. PMID 804826.