Pancreatic abscess: Collection of pus in pancreas

A pancreatic abscess is an area filled with pus in the pancreas. Severe inflammation of the pancreas (pancreatitis) or pseudocysts in the pancreas are usually the cause of these abscesses, although other causes are also known. Abdominal pain, fever and vomiting are some symptoms of a pancreatic abscess. In addition to a thorough medical history and blood test, imaging tests are necessary to diagnose the serious condition. The doctor must drain the pus through surgery so that the patient can recover. Untreated, pancreatic abscesses often lead to death.

  • Causes of collection of pus in pancreas
  • Pseudocysts
  • Pancreatitis
  • Other causes
  • Symptoms
  • Diagnosis and examinations
  • Therapy
  • Prognosis
  • Complications of pancreatic abscesses
  • Prevention of pancreatic abscess

 

Causes of collection of pus in pancreas

Pseudocysts

A pancreatic abscess is a collection of pus in the pancreas. Pancreatic abscesses usually develop in patients with pancreatic pseudocysts that become infected. A pseudocyst is not a true cyst because the wall of the pus sac does not consist of a specific lining of cells characteristic of a true cyst.

Pancreatitis

Furthermore, a pus-filled area in the pancreas also develops in patients with severe pancreatitis. Approximately 3% of patients with acute pancreatitis develop an abscess in the pancreas.

Other causes

Other causes include gallstones or alcohol and occasionally drug use, blunt trauma, and other abscess to nearby structures.
Germs
The most common causing germs include E. coli, Klebsiella, Enterococcus, Staphylococcus, Streptococcus and Pseudomonas species, but fungi can also cause an abscess.

Symptoms

Common symptoms of a pancreatic abscess include abdominal pain (epigastric pain = pain in the center of the upper abdomen), chills, fever, inability to eat, weight loss, food intolerance and a general feeling of illness. Some patients experience swelling in the abdomen (palpable tender mass). Nausea and vomiting are also other possible signs.

Diagnosis and examinations

Interview
Most patients who develop pancreatic abscesses have had pancreatitis, usually with a prolonged course. However, the development of the complication often takes seven or more days. The doctor therefore needs a complete medical history.
Diagnostic examination
A blood test is also required. The number of white blood cells is increased, which may indicate the presence of an abscess. An abdominal CT scan (CT scan of the abdomen), MRI scan and ultrasound are useful in obtaining clear images of the inside of the abdomen. These imaging tests reveal the presence of infected necrosis that has not yet developed into an abscess. Therefore, the doctor usually orders repeat imaging studies in patients with acute pancreatitis whose abdominal pain worsens and who develop signs of abdominal obstruction (a blockage in the abdomen).
Differential diagnosis
An abdominal abscess and pancreatic cancer are differential diagnoses for a pancreatic abscess.

Therapy

The doctor must first drain the abscess through the skin (percutaneously) (drain pus) so that the patient can recover. This usually requires a surgical procedure to remove dead tissue and drain the pus. In some cases, abscess drainage is possible through an endoscope using endoscopic ultrasound. Finally, the doctor occasionally uses broad-spectrum antibiotics, although this treatment is controversial.

Prognosis

The outlook for patients with a pancreatic abscess is generally based on the severity of the infection. However, it is a serious complication that sometimes leads to the death of the patient if he does not receive proper treatment. Patients are at risk of sepsis (blood poisoning) and multiple organ failure. If the doctor does not surgically remove the infected abscess, the mortality rate increases to 100%.

Complications of pancreatic abscesses

An unremoved infected abscess may lead to sepsis. Sometimes multiple abscesses also appear. Other complications include fistula formation and recurrent pancreatitis.

Prevention of pancreatic abscess

In some cases it is possible to prevent abscesses. The doctor may drain an existing pseudocyst because it is likely to become inflamed and then lead to a pancreatic abscess. In most cases, however, the formation of abscesses in the pancreas cannot be prevented.

read more

  • Acute pancreatitis: Inflammation of the pancreas with abdominal pain
  • Pancreatitis: Pancreatitis with abdominal pain
  • Abscess in skin or body: Pus due to infection with bacteria
  • Drain abscess (bag of pus due to bacterial infection).
  • Necrotizing pancreatitis: Death of parts of the pancreas
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