In the majority of cases, pancreatic abscess occurs after a severe bout of acute pancreatitis usually more than 4-6 weeks after the initial attack. The mortality rate of pancreatic abscess can be high if the diagnosis is missed.
In the USA there are about 20,000 cases of pancreatic abscesses each year resulting after severe acute pancreatitis. In some cases, the pancreatic abscess is localized and contained with the confines of a cyst but in others, the abscess may be liquefied and free.
Pancreatic abscess causes include gallstones or alcohol consumption. In very rare cases, pancreatic abscess causes may include drugs and blunt trauma.
The typical symptoms of a pancreatic abscess include nausea, vomiting, severe abdominal pain, skin discoloration of the abdomen near the umbilicus and flanks and fever. Most people have no appetite and are quite ill when there is a pancreatic abscess.
The diagnosis of an abscess is made with various radiological studies including a CT scan or an MRI. In many early cases of a pancreatic abscess, the diagnosis can be difficult as the tissues are not well visualized by the CT scan. If there is fluid accumulated in the pancreas, it may be aspirated and sent to the laboratory to be analyzed for bacteria.
When a pancreatic abscess has been confirmed, the treatment is supportive. Most of these patients need aggressive fluid hydration and antibiotics. There are various ways to drain the pancreatic abscess and this depends on the location. This may include use of CT scan to aspirate all the pus and insert a tube in the area to drain the rest of the pus out. Other methods of drainage include ERCP- in this procedure a camera is placed through the mouth and directed to the duodenum, a small hole is created in the duodenum to allow the pus to drain.
Surgery is also frequently used to treat patients with abscesses. The procedure requires general anesthesia and the surgeon simply takes out all the necrotic material and leaves drainage tubes.
Recovery after pancreatic abscess can be long and many patients may be placed on intravenous nutrition for several months. Pancreatic abscess complications can prolong the healing time and the process is often associated with lung and kidney failure. The aim of intravenous nutrition is to allow the pancreas to rest and recover.
Care of patients with a pancreatic abscess is usually done in an intensive care unit as these patients can quickly decompensate. During the recovery period, pancreatic abscess complications may include fistulas (fluid which drains from the pancreas outside on to the skin), recurrent pancreatitis, bowel obstruction and even death.
The best way to avoid a pancreatic abscess is to ensure that one does not develop pancreatitis. This means avoiding alcohol which is the major cause of pancreatitis worldwide. Individuals who have gallstones should consider getting them removed if they are prone to pancreatitis. Pancreatic abscess treatment is successful when the diagnosis is made promptly.
