Sandbox:pancreatic abscess

Overview

Pancreatic abscess is an unusual and rare, but life threatening complication of acute pancreatitis.

Causes

Common Causes

Common organisms causing pancreatic abscess are as follows:

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.

• Recurrent pancreatitis

Natural History, Complications and Prognosis

Complications

• Intra abdominal sepsis

Gastric complications

• GI bleeding
• Gastric outlet obstruction

Colon complications

Diagnosis

History and Symptoms

Common Symptoms

Common symptomatic presentation of pancreatic abscess include:

• Abdominal pain
• Back pain
• Nausea and vomiting
• Weight loss

Less common symptoms

• Melena
• Diarrhoea

Vital signs

• High grade fever (greater than 37.8°C)
• Upper abdominal pain
• Failure to thrive

Physical Examination Findings

• Abdominal tenderness
• 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 gas bubbles suggesting abscess

Ultrasound

• Shows fluid filled sac suggesting abscess