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Pancreatic Abscess

Pancreas Abscess


Presentation

  • He initially presented with alcohol-induced acute pancreatitis. Twenty days after the initial presentation, he re-presented with increasing pain and was found to have pancreatic necrosis and abscesses. Treatment was initiated with meropenem.[ncbi.nlm.nih.gov]
  • In both patients, the tumor was unresectable at presentation. A detailed review of these cases is presented as well as a review of the related literature.[ncbi.nlm.nih.gov]
  • Acute pancreatitis occasionally presents as pancreatic abscess with complications like pleural effusion and ascites.[ncbi.nlm.nih.gov]
  • Twenty patients (20%) died, but Ranson's signs did not predict outcome. pancreatic abscess may have an insidious presentation.[ncbi.nlm.nih.gov]
  • We report four patients who each presented with a pancreatic mass at the pancreas head or body without acute pancreatitis. The presenting symptoms were abdominal pain, fever, or weight loss.[ncbi.nlm.nih.gov]
Fever
  • On the 26th day of the first intervention, the patient had fever and abdominal pain and his clinic was deteriorated.[ncbi.nlm.nih.gov]
  • We describe a 64-year-old Filipino woman who presented 2 weeks after elective cholecystectomy and pancreatic biopsy with left upper quadrant pain, abdominal distention, and fever.[ncbi.nlm.nih.gov]
  • Because of persistent fevers, computed tomography-guided drainage was performed. The fluid grew A faecalis resistant to meropenem and the patient continued to be febrile.[ncbi.nlm.nih.gov]
  • Abstract A 35-year-old man sought treatment for acute epigastric pain, mild jaundice, and high fever.[ncbi.nlm.nih.gov]
  • All 5 patients had acute pancreatitis followed by prolonged fever and development of an abdominal mass. The diagnosis was confirmed in each of them by a contrast enhanced CT scan and an ultrasound guided aspiration of pus from the pancreatic mass.[ncbi.nlm.nih.gov]
Intravenous Drugs
  • We report a case of a tuberculous pancreatic abscess in a 47-year-old human immunodeficiency virus positive intravenous drug abuser. She had a prolonged febrile course and persistent abdominal pain.[ncbi.nlm.nih.gov]
  • Two patients with a history of intravenous drug abuse developed a pancreatic abscess due to mycobacterial infection as their initial evident opportunistic infection in association with the acquired immunodeficiency syndrome (AIDS).[ncbi.nlm.nih.gov]
Recurrent Infection
  • Pancreatic abscess The most common complication requiring intervention after necrosectomy is a residual or recurrent infection, mostly pancreatic abscesses.[gut.bmj.com]
Abdominal Pain
  • On the 26th day of the first intervention, the patient had fever and abdominal pain and his clinic was deteriorated.[ncbi.nlm.nih.gov]
  • She had a prolonged febrile course and persistent abdominal pain.[ncbi.nlm.nih.gov]
  • All patients presented with persistent fever and abdominal pain.[ncbi.nlm.nih.gov]
  • Signs and symptoms [ edit ] Patients with pancreatic abscesses may experience abdominal pain, chills and fever or the inability to eat. Whereas some patients present an abdominal mass, others do not. Nausea and vomiting may also occur.[en.wikipedia.org]
  • The presenting symptoms were abdominal pain, fever, or weight loss. Abdominal CT scans showed low-density round masses at the pancreas head or body with/without lymphadenopathy.[ncbi.nlm.nih.gov]
Epigastric Pain
  • Abstract A 35-year-old man sought treatment for acute epigastric pain, mild jaundice, and high fever.[ncbi.nlm.nih.gov]
  • A 50-year-old female was referred to our hospital because of postprandial epigastric pain and pancreatic head mass. On admission, an elastic hard mass with tenderness was palpable in the epigastric region.[ncbi.nlm.nih.gov]
  • The clinical presentation of pancreatitis varies from case to case, with epigastric pain, nausea and vomiting being the commonest symptoms as observed in the present case.[ijpmonline.org]
  • Acute pancreatitis usually presents with epigastric pain radiating to the back, nausea and vomiting, and epigastric tenderness on palpation.[amboss.com]
  • CASE REPORT A 59-year-old woman with severe epigastric pain and fever lasting 3 days was referred to our hospital. At admission, she complained of abdominal pain and fever.[ncbi.nlm.nih.gov]
Left Upper Quadrant Pain
  • We describe a 64-year-old Filipino woman who presented 2 weeks after elective cholecystectomy and pancreatic biopsy with left upper quadrant pain, abdominal distention, and fever.[ncbi.nlm.nih.gov]
Left Upper Quadrant Pain
  • We describe a 64-year-old Filipino woman who presented 2 weeks after elective cholecystectomy and pancreatic biopsy with left upper quadrant pain, abdominal distention, and fever.[ncbi.nlm.nih.gov]
Tachycardia
  • Capillary leakage : Release of inflammatory cytokines and vascular injury by pancreatic enzymes vasodilation and increased vascular permeability shift of fluid from the intravascular space into the interstitial space ( third space loss ) hypotension, tachycardia[amboss.com]
  • Resolution of fevers, tachycardia and hypotension, as well as improvement in any associated abdominal pain are all potential markers of clinical improvement in this condition, although none are specific to this diagnosis..[clinicaladvisor.com]

Workup

  • They’ll also order tests, which may include: blood workup urine analysis ultrasound X-ray MRI CT scan To distinguish among cellulitis, abscess, and phlegmon, your doctor may use intravenous gadolinium with MRI to show the outline of an abscess “wall”[healthline.com]
Left Pleural Effusion
  • There was moderate ascites, left-sided basal consolidation was noted in the left lung along with mild left pleural effusion. USG liver showed diffuse Grade 1 increase in echotexture. No local solid or cystic lesion was seen.[ijpmonline.org]
  • pleural effusion CT Focal or diffuse enlargement of the pancreas Heterogeneous enhancement Indistinct or shaggy margins Infiltration of the peripancreatic fat Fluid collections in the peripancreatic and anterior pararenal spaces MRI Used primarily in[learningradiology.com]
Gastric Fistula
  • The spontaneous gastric fistula was heralded by a large emesis of purulent and necrotic material in one case and copious nasogastric tube secretions of a similar material in the other.[ncbi.nlm.nih.gov]
X-Ray Abnormal
  • Abscesses near the diaphragm may result in chest x-ray abnormalities such as ipsilateral pleural effusion, elevated or immobile hemidiaphragm, lower lobe infiltrates, and atelectasis. CBC and blood cultures should be done.[msdmanuals.com]
Pancreatic Calcification
  • calcification 膵線維化 pancreatic fibrosis 花筵状線維化 storiform fibrosis 膵内胆管浸潤 intrapancreatic bile duct invasion 膵嚢胞 pancreatic cyst 仮性嚢胞 pseudocyst 感染性膵仮性嚢胞 infected pancreatic pseudocyst 真性嚢胞 true cyst 先天性嚢胞 congenital cyst 単純性嚢胞 simple cyst 嚢胞線維症 cystic[jsge.or.jp]
Salmonella Typhi
  • Isolated involvement of the pancreas in Salmonella typhi bacteraemia is rare. A case of pancreatic abscess due to S. typhi is reported which was managed conservatively.[ncbi.nlm.nih.gov]
  • Pancreatic abscess due to Salmonella typhi. Postgrad Med J 1992; 68:294-5. [PMID 1409199] Eliashiv A, Olumide F, Norton L, Eiseman B. Depression of cell-mediated immunity in diabetes. Arch Surg 1978; 113:1180-3. [PMID 309322][pancreas.imedpub.com]

Treatment

  • It expands the potential for endoscopic treatment in patients with pancreatic necrosis and/or pancreatic abscess.[ncbi.nlm.nih.gov]
  • However, CT-guided drainage is the option treatment for patients who may not tolerate an open procedure. Endoscopic treatment is at the same time a treatment option that increased in popularity over the last years.[en.wikipedia.org]
  • The EUS-guided treatment was effective for improvement of severe inflammation of the pseudocyst as an initial treatment. However, drainage tube placement limitations pertained because the pseudocyst was present with multilocular infection.[ncbi.nlm.nih.gov]
  • Treatment was initiated with meropenem. Because of persistent fevers, computed tomography-guided drainage was performed. The fluid grew A faecalis resistant to meropenem and the patient continued to be febrile.[ncbi.nlm.nih.gov]
  • BACKGROUND: Experience with endoscopic transmural drainage of pancreatic pseudocysts prompted the use of a similar technique for the primary treatment of pancreatic abscess.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis may be worse in obese patients, after trauma, after organ transplantation, after coronary artery bypass surgery, or in idiopathic AP. [3] Morbidity/mortality In the first 48-72 hours after the onset of acute pancreatitis using the Sepsis-Related[emedicine.medscape.com]
  • On the basis of this experience, it is possible to establish a relationship between the gross appearance of the collection and the underlying pancreatic disease with differences in terms of prognosis, morbidity, and mortality.[ncbi.nlm.nih.gov]

Etiology

  • A case of pancreatic abscess with pancreaticobiliary fistula manifesting as obstructive jaundice of occult etiology is presented. Diagnosis was made preoperatively by skinny needle percutaneous transhepatic cholangiography.[ncbi.nlm.nih.gov]
  • Prognostic factors analyzed included number of Ranson criteria, etiology, type, and number of microorganisms isolated, extent of abscess, time to diagnosis and operation, and technique of surgical drainage.[ncbi.nlm.nih.gov]
  • The etiological, clinical, and biochemical features of each group of patients are reported and discussed. Computed tomography availability seems to be the most important improvement reported as regards diagnosis and surgical tactics.[ncbi.nlm.nih.gov]
  • Our own experience with liver abscesses shows that diabetes mellitus is an important risk factor for abscesses without other etiologies.[pancreas.imedpub.com]
  • This case report indicates that any patient presenting with a perinephric abscess of unknown etiology not responding to conventional treatment modalities should be investigated for underlying pancreatitis.[pancreas.imedpub.com]

Epidemiology

  • Epidemiology References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Stimac D, Mikolasevic I, Krznaric-Zrnic I, et al ; Epidemiology of Acute Pancreatitis in the North Adriatic Region of Croatia during the Last Ten Years. Gastroenterol Res Pract. 20132013:956149. doi: 10.1155/2013/956149. Epub 2013 Feb 14.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Corresponding to the lack of pathophysiologic effects of AP per se, pulmonary and renal insufficiencies occur in only 33.3% and 16.7%, respectively, and mortality in these patients is 22.2%.[ncbi.nlm.nih.gov]
  • This volume summarizes several important updates in abdominal surgery and pathophysiology.[books.google.com]
  • Pathophysiology ANP is the most severe end of a spectrum of inflammation associated with pancreatitis. Inflammation causes cell death with resultant devitalized tissue, which is likely to become infected.[odlarmed.com]
  • References: [1] [2] [3] [4] Pathophysiology Sequence of events leading to pancreatitis : Intrapancreatic activation of pancreatic enzymes : secondary to pancreatic ductal outflow obstruction (e.g., gallstones, cystic fibrosis ) or direct injury to pancreatic[amboss.com]
  • There has been great improvement in knowledge of the natural course and pathophysiology of acute pancreatitis over the past decade. 1– 4 The clinical course of acute pancreatitis varies from a mild transitory form to a severe necrotising disease.[gut.bmj.com]

Prevention

  • Also, it is recommended that patients who have a prolonged clinical response are tested repeatedly as a prevention method to avoid the development of an abscess that may rupture. [4] Prevention [ edit ] In some cases, abscesses may be prevented by draining[en.wikipedia.org]
  • However, in many cases, the disorder is not preventable. Barshak MB. Pancreatic infection. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed.[nlm.nih.gov]
  • Prevention Draining a pancreatic pseudocyst may help prevent some cases of pancreatic abscess. However, in many cases the disorder is not preventable.[coordinatedhealth.com]
  • It is suggested that retrograde infection from the fistula was prevented by the single fistulization to the acidic duodenal bulb, which is not supposed to allow most bacterial growth.[ncbi.nlm.nih.gov]
  • Prevention Draining a pancreatic pseudocyst may help prevent some cases of pancreatic abscess. However, in many cases the disorder is not preventable. Images References Barshak MB. Pancreatic infection. In: Bennett JE, Dolin R, Blaser MJ, eds.[ufhealth.org]

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