Pancreatic Necrosis and Pancreatic Abscess Clinical Presentation
- Author: Abraham Mathew, MD, MS; Chief Editor: BS Anand, MD more...
Patients with pancreatic necrosis and pseudocysts will have definitive history of pancreatitis (often with a prolonged course), hemodynamic instability, fever, failure of medical therapy, or the presence of peripancreatic fluid collections on computed tomography (CT) scan.
Acute infection can set in in the pancreatic bed and lead to infected pancreatic necrosis and sepsis. When this occurs, it is usually presents 10-12 days into the course of severe pancreatitis. Pancreatic abscess formation takes weeks to develop, as does WOPN. WOPN can then later become infected.
Patients with WOPN may be asymptomatic (50%) or present with symptoms (50%) such as abdominal pain, malaise, relapsing or recurrent pancreatitis, feeding intolerance, and/or weight loss.[1, 6] In severe cases, WOPN can obstruct the gastrointestinal tract, fistulize to adjacent anatomic structures, and compress or erode into blood vessels or the bile duct.
Abdominal pain with or without a mass on palpation of the epigastrium is suggestive of parietal peritoneal irritation.
Classic physical examination findings, such as Grey-Turner sign or Cullen sign, are supposedly characteristic of pancreatitis but rarely are noted in clinical practice.
Other physical findings are nonspecific and include abnormal vital signs consistent with sepsis, abdominal guarding, and rebound tenderness.
The inciting events for pancreatitis are legion; however, cholelithiasis and alcohol account for more than 80% of cases in the developed world.
Peripancreatic fluid encased in a fibrinous capsule defines pseudocysts. It is often the result of a ductal leak or disruption.
Superinfection of pseudocysts lead to the development of pancreatic abscesses. Evidence suggests that colonic translocation of bacterial flora accounts for many cases of pancreatic infection.
The most typical organisms isolated from infected necrosis and abscesses are enteric bacteria and Candida species.
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