What is Pancreatic Abscess?
Pancreatic fluid pools, debris gathering, and abscesses (which are pockets of pus) often occur due to serious inflammation of the pancreas, also known as acute necrotizing pancreatitis. In accordance to the most recent classifications, these complications can be split into two categories: acute, which is when the fluid pool has been there for under four weeks, and delayed, which is when the fluid pool has been present for more than four weeks.
In the early stage or acute phase, the fluid pool near the pancreas isn’t clearly defined and is known as a ‘peripancreatic fluid collection’. After four weeks, the fluid pool becomes more structured, gaining a definite fibrous wall (like a layer of plant fibers), and it’s then called a ‘pseudocyst’. A pseudocyst is a type of cyst filled with pancreatic enzymes with a fibrous wall but unlike normal cysts, it doesn’t have a cellular lining.
If this pseudocyst becomes infected, it then becomes a pancreatic abscess, or an infected pocket of pus.
What Causes Pancreatic Abscess?
A pancreatic abscess is a pocket of pus that forms inside the abdomen, often near the pancreas. This usually happens due to an infection caused by the movement of bacteria from the colon. Patients who have developed an infected pancreatic pseudocyst—a sac of fluid on the pancreas—are often the ones who develop pancreatic abscesses.
The bacteria that usually cause these abscesses are the so-called gram-negative bacteria, especially Escherichia coli, Klebsiella, and Pseudomonas. Gram-positive bacteria, such as Enterococcus, are also occasionally the cause. People suffering from pancreatitis—an inflammation of the pancreas—whose condition doesn’t improve with initial treatment and who start to show signs of systemic inflammatory response syndrome (an extreme reaction to infection) may be suspected to have a pancreatic abscess or another kind of infection inside the abdomen.
Other factors contributing to pancreatic abscesses include peptic ulcers (sores in the stomach lining), gallstones, and heavy drinking since these increase the risk and frequency of pancreatitis episodes. In rare cases, certain medications, blunt force trauma, or abscesses spreading from nearby organs, too can lead to a pancreatic abscess.
Risk Factors and Frequency for Pancreatic Abscess
Acute pancreatitis, a severe stomach condition, is one of the main reasons people are admitted to the hospital for gastrointestinal issues in the U.S. Every year, between 13 and 45 out of every 100,000 people are diagnosed with this condition. Sometimes, people with acute pancreatitis can develop a pancreatic abscess, which is a type of complication. However, the exact rates and details about this particular disease are not well-known.
Signs and Symptoms of Pancreatic Abscess
The diagnosis of a pancreatic abscess is largely dependent on the patient’s medical history. Typically, this condition is seen in patients who have a history of pancreatitis or are susceptible to it. Common symptoms in pancreatitis patients include stomach pain, especially in the upper abdomen that radiates to the back and tends to worsen after eating. These individuals may also experience nausea and vomiting. It is beneficial to consider the various causes of pancreatitis during diagnosis.
- Unknown cause (idiopathic)
- Gallstones
- Alcohol (ethanol)
- Physical injury (trauma)
- Steroids
- Mumps
- Autoimmune pancreatitis
- Excess calcium in the blood (hypercalcemia)
- High triglycerides (hypertriglyceridemia)
- Post-ERCP (a procedure to treat pancreatic and bile duct conditions)
- Certain medications like ACE inhibitors, macrolides, mesalamine, fibrates, etc.
Red flags for possible pancreatic infection include persistent fevers, escalating abdominal pain, and little to no improvement despite receiving initial treatment. An infection is suspected in patients who haven’t improved after a week to 10 days of hospital care and supportive treatments, or in those whose condition rapidly worsens. Even though pancreatitis can cause systemic inflammation, any additional infection should be suspected if these symptoms are present.
During a physical examination, the symptoms in patients with pancreatic infections are usually similar to those of acute pancreatitis but can be more severe. They typically manifest after 7 to 10 days of hospitalization. The abdominal pain is usually localized in the upper abdomen, and there may or may not be a palpable mass. In severe cases of pancreatitis, patients often appear dehydrated when they present. Signs such as low blood pressure and insufficient oxygen (hypoxia) could signal a progression towards shock. While fevers could be linked to an underlying infection, they can also occur due to ongoing inflammation of the pancreas.
Testing for Pancreatic Abscess
If your doctor suspects that you have an infection in your pancreas, they may order a series of lab tests to help confirm this. These could include a full blood count, a basic metabolic panel (which checks your electrolyte balance, sugar levels, and kidney function), liver function tests, the erythrocyte sedimentation rate (a test that measures inflammation in your body), C-reactive protein (another inflammation test), lactate dehydrogenase (a test involved in energy production), and blood cultures (to check for bacteria or other organisms in your blood).
Although none of these tests are specific to conditions affecting the pancreas, they can give your doctor a better overall picture of what’s going on in your body. For example, a C-reactive protein level greater than 150 or a hematocrit (the percentage of your blood that’s made up of red blood cells) over 44% can both indicate the presence of a serious pancreatic condition like pancreatic necrosis or the development of an abscess.
If your condition doesn’t improve with initial treatment, your doctor may then move on to imaging tests. A CT scan or an MRI scan with a special dye (contrast) can provide a more detailed picture of your pancreas and help identify any necrosis (dead tissue) or abscesses (pockets of pus). The CT scan is the most commonly used of the two, and signs of infection include gas seen outside of the normal digestive tract in and around the pancreas area.
Treatment Options for Pancreatic Abscess
If you have a pancreatic abscess, your doctor will likely suggest several tests and treatments. These might include a Complete Blood Count (CBC) test, which measures the different types of cells in your blood. They may also want to perform blood cultures, which can help detect bacteria in your blood.
To get a more detailed look at your pancreas and confirm the diagnosis, your doctor will likely order imaging tests, such as a CT scan using a contrast dye, or an MRI scan using a substance called gadolinium. If you have kidney problems, you may have an MRI without contrast instead.
If the tests show signs of infection, your doctor will start you on antibiotics that work against a wide range of bacteria. In some cases, especially for those who cannot tolerate certain types of antibiotics, a combination therapy with other antibiotics might be used as an alternative. To further investigate and confirm the infection, your doctor might recommend a CT-guided fine-needle aspiration. This procedure uses a thin needle to remove a sample from the abscess, guided by images from a CT scan.
When it comes to treatment, there are different approaches for different patients. Patients who are hemodynamically unstable, meaning their blood circulation is not stable, might be recommended a surgical procedure to clean out the infected tissue (debridement). On the other hand, patients who are hemodynamically stable may undergo less invasive methods, which include using an endoscope to perform removal of necrotic (dead) tissue (necrosectomy) and drainage.
As treatment progresses, signs of improvement may include less rapid heart rate (tachycardia), fewer fevers, improved blood pressure (hypotension), and less abdominal pain. However, these signs can be general and not specific to the pancreatic abscess. Your doctor will consequently monitor your condition by undertaking daily CBC tests and checking to see if the level of white blood cells (leukocytosis) is decreasing. If the abscess has been causing bacteria to enter your blood (bacteremia), your doctor will use blood cultures to track the infection’s progress and confirm its eventual clearance.
What else can Pancreatic Abscess be?
The following conditions could potentially be mistaken for each other because they share similar symptoms:
- Pancreatic pseudocysts
- Pancreatic necrosis without an associated infection
- Gastric ulcer
- Ascending cholangitis
- Acute cholecystitis
- Mesenteric ischemia
- Bowel obstruction
- Perforated viscus (a ruptured or punctured organ)
What to expect with Pancreatic Abscess
The outcome for the patient really depends on how severe the infection is. It’s a potentially serious complication that could sadly lead to the patient’s death if they don’t receive the right treatment. Patients risk severe damage to multiple organs and a serious condition called sepsis, where the body’s response to infection causes injury to its own tissues and organs.
If the abscess, or pocket of pus that has built up within body tissue, isn’t removed through surgical or endoscopic means – endoscopy being a non-surgical procedure using a flexible tube to examine the inside of the body – the mortality rate could be as high as 100%. So, it’s really important to treat this condition urgently and effectively.
Possible Complications When Diagnosed with Pancreatic Abscess
- Multiple pus-filled areas
- Growing Abscesses
- Body-wide infection
- Severe and sudden drop in blood pressure caused by infection
- Failure of multiple body organs
- Formation of an abnormal connection between different body parts
- Potential death
Preventing Pancreatic Abscess
Acute pancreatitis, a condition that causes inflammation in the pancreas, is among the most frequent stomach-related illnesses that require hospitalization. It’s essential for patients to understand that this condition is typically managed with treatments like IV fluids. However, complications from pancreatitis can be very serious and might result in death. Consequently, it’s essential to emphasize the role of lifestyle choices in preventing pancreatitis.
One of the largest preventable triggers for acute pancreatitis is overconsumption of alcohol. Patients are advised to keep their alcohol consumption in check. Additionally, leading a healthy lifestyle is key in preventing this condition. Patients are encouraged to completely avoid smoking, maintain a well-rounded diet and partake in regular exercise. This lifestyle can help prevent gallstones – hard particles that develop in the gallbladder – which are one of the most common triggers for pancreatitis.
