How Do I Treat a Pancreatic Abscess?

Pancreatic abscesses are caused by necrotic tissue of acute pancreatitis or secondary infection with pseudocysts. They can occur in any part of the pancreas. The main pathogenic bacteria are intestinal bacteria. Abscess ulceration corrodes adjacent organs and can cause intestinal fistulas or bleeding.

Basic Information

Visiting department

Gastroenterology

Common locations

pancreas

Common causes

Necrotizing pancreatitis or focal necrosis of pancreatic fat, secondary infection with liquefaction

Common symptoms

Persistent tachycardia, increased breathing, intestinal paralysis, increased abdominal pain, back pain, etc.

Causes of pancreatic abscess

Pancreatic abscess is formed by necrotizing pancreatitis or focal necrosis of fat around the pancreas and secondary infection by liquefaction.

Clinical manifestations of pancreatic abscess

Patients with acute pancreatitis behave as if they have sepsis, but no other cause can be found, which highly suggests pancreatic abscess. Pancreatic abscesses can be insidious or fulminant. At this time, the patient's original symptoms and signs changed and exacerbated, including persistent tachycardia, accelerated breathing, intestinal paralysis, and increased abdominal pain, accompanied by lower back pain, increased peripheral white blood cell count, and the patient was poisoned, and his temperature gradually increased. , Occasional gastrointestinal symptoms (such as nausea, vomiting and loss of appetite). A few patients have symptoms of diabetes.

Physical examination revealed tenderness in the upper abdomen or the whole abdomen, with palpable masses. However, in a small number of patients, fever may be absent, showing only persistent tachycardia, mild loss of appetite, atelectasis, and mild liver dysfunction.

In the course of acute pancreatitis, there may be pancreatic abscesses when high fever, marked increase in peripheral white blood cell count and left shift, increased abdominal pain, abdominal mass, and systemic toxicity symptoms. Serum amylase was elevated in some cases. There may be liver damage, which is manifested by an increase in serum transaminase and alkaline phosphatase, renal damage in some cases, and an increase in serum urease and creatinine.

Pancreatic abscess examination

Laboratory inspection

The white blood cell count increased significantly, often reaching (20-50) × 10 ⁹ / L; bacterial growth was possible in blood culture; serum and urinary amylase continued to increase, and lasted for more than 1 week.

2. Imaging examination

(1) CT examination The CT film shows the accumulation of liquid, especially the presence of gas in the accumulated liquid is a pathological feature of abscess formation, and the presence of gas in the abscess is the main indicator.

(2) Type B ultrasound examination Type B ultrasound examination can show the presence, size, number, and location of pancreatic abscesses, but there are certain restrictions on severe acute pancreatitis.

(3) X-ray chest X-ray shows that the left diaphragm is elevated, the left lower lung is not atelectic, and some may have obvious pleural effusion.

(4) Plain film of the abdomen Most small air bubbles are found in the pancreas area, that is, small air bubbles or air-liquid cavities (caused by gas-producing bacteria infection in the abscess). In addition, transverse colon paralysis was seen, and gas accumulation in the gastrointestinal tract showed a translucent area resembling a "soap bubble".

(5) Examination of barium meal in the gastrointestinal region The signs of enlargement of the pancreas area, widening of the duodenal ring, and displacement of the stomach and transverse colon in different degrees and directions according to different parts and sizes of the abscess.

(6) Magnetic resonance imaging can show signs of enlarged pancreas and sparse blood vessels in the pancreatic abscess area.

Pancreatic abscess diagnosis

B-ultrasound and CT examinations are the main means to determine the diagnosis. B-mode ultrasound can show the presence, size, number, and location of pancreatic abscesses. CT guided percutaneous aspiration of pancreatic pus can not only confirm the diagnosis, but also can be used for Gram staining and culture. Infected bacteria are usually Gram-negative bacilli, such as Escherichia coli, Pseudomonas, Klebsiella, and Proteus. Certain positive bacteria may also be present, such as Staphylococcus aureus and certain anaerobic bacteria, and they can also be infected with mixed bacteria. The combination of the two can make an accurate diagnosis with high accuracy. Therefore, the presence of pus, with little or no pancreatic necrotic tissue, and a positive bacterial or fungal culture are the main points for the diagnosis of pancreatic abscess, which can be distinguished from non-infectious pancreatic necrosis.

Differential diagnosis of pancreatic abscess

Pancreatic pseudocyst

A few days to months after acute pancreatitis, recurrent pancreatitis, or upper abdominal trauma, an increasing painless or dull pain mass appears in the upper abdomen with clear mass boundaries, no fever, and no sepsis There was no change in blood image. Ultrasonography and CT examination were clear-cut cystic masses.

2. Chronic pancreatitis mass

It is a complication of late acute pancreatitis or chronic pancreatitis. The upper abdomen has mild pain and low fever. There is no sepsis. The upper abdomen can touch an unclear mass. B-ultrasound and CT examination are solid masses. More.

Pancreatic abscess complications

1. Transverse colon perforation and lower gastrointestinal bleeding

It is one of the serious complications of pancreatic abscess, which mostly occurs in the acute phase of the disease. The development process is firstly a pancreatic abscess or a pancreatic pseudocyst that infects and emits blood, eventually leading to colon necrosis and perforation.

2. Abdominal bleeding

Caused by an abscess invading a blood vessel, such as the splenic artery, left gastric artery, gastroduodenal artery, or superior mesenteric vein.

3. Abdominal multiple abscess

Pancreatic abscesses spread to the sides along the peritoneum, up to the subcondyle, and even the mediastinum, and down the paracolonic groove or psoas muscle to the groin.

4. Concurrent fistula

Duodenal fistula, jejunal fistula, gastric fistula, pancreatic fistula and so on.

5. Other

Delayed gastric emptying, diabetes.

Pancreatic abscess treatment

The treatment method is surgery or drainage. Medical support and antibiotics alone are not enough, because they may cause abscess ulceration and sepsis.

Medical treatment

Medical treatment is the basis of pancreatic abscess treatment. Active anti-infective treatment can prevent the occurrence of bacteremia and abscess complications. After surgery and percutaneous puncture and drainage, active anti-infective treatment is also required. According to the in vitro culture of pathogenic bacteria, For infected bacteria, choose effective antibiotics reasonably. Use antibiotics that can penetrate the blood-pancreatic barrier. If the infectious bacteria cannot be identified, it is usually a combination of multiple antibiotics.

Secondly, a strong pancreatic enzyme inhibitor should be used to provide systemic supportive treatment as much as possible, and supplement protein, fat, sugar, vitamins and electrolytes.

2. Percutaneous puncture and drainage

Percutaneous puncture of the abscess under ultrasound or CT guidance, followed by catheter drainage, can be used as an initial treatment of pancreatic abscess or single abscess accumulation. However, the percutaneously placed catheters are thin, and it is difficult to drain the necrotic debris and thick pus, and multiple drainage catheters are often placed. Drainage success rate is 9% to 15%, so it cannot replace surgical drainage.

3. Surgical treatment

The earlier the pancreatic abscess is treated, the better the result. Detecting all abscesses and thoroughly draining them is a prerequisite for successful treatment. The main reason for the persistence and recurrence of postoperative abscesses is often poor drainage. The effectiveness of surgical treatment depends to a large extent on the timely diagnosis. If the diagnosis is delayed, the mortality rate tends to increase significantly. The cause of death is often sepsis caused by the necrotic part, followed by the etiology and comorbidities. Successful surgery and reoperation if necessary, postoperative drainage and lavage, active anti-infection and supportive treatment can generally cure pancreatic abscesses.

Prognosis of pancreatic abscess

It has to do with whether the operation is early or late and the drainage. If an abscess invades adjacent organs, it can cause intestinal fistulas and bleeding.

Pancreatic abscess prevention

Actively treat biliary diseases, quit smoking and avoid overeating. For infectious diseases, antibiotic treatment should be strengthened. The disease is a complication that occurs after acute pancreatitis or pancreatic injury. Therefore, the key to the prevention of this disease is to make an early diagnosis of acute pancreatitis or pancreatic injury and make correct treatment in time.