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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

  • History of alcoholic pancreatitis who fails to respond to medical therapy[1][3]

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. 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.
  2. ALTEMEIER WA, ALEXANDER JW (1963). "Pancreatic abscess. A study of 32 cases". Arch Surg. 87: 80–9. PMID 14012297.
  3. 3.0 3.1 Miller TA, Lindenauer SM, Frey CF, Stanley JC (1974). "Proceedings: Pancreatic abscess". Arch Surg. 108 (4): 545–51. PMID 4815930.

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