Pancreatic abscess

Definition

A pancreatic abscess is an area filled with pus within the pancreas.

Causes

Pancreatic abscesses develop in people who have:

• Pancreatic pseudocysts
• Severe pancreatitis that becomes infected

Symptoms

Symptoms include:

• Abdominal mass
• Abdominal pain
• Chills
• Fever
• Inability to eat
• Nausea and vomiting

Exams and Tests

Most people with pancreatic abscesses have had pancreatitis. However, the complication often takes 7 or more days to develop.

Signs of an abscess can be seen on:

• CT scan of the abdomen
• MRI of the abdomen
• Ultrasound of the abdomen

Blood culture will show high white blood cell count.

Treatment

It may be possible to drain the abscess through the skin (percutaneous). Abscess drainage can be done through an endoscope using endoscopic ultrasound (EUS) in some cases. Surgery to drain the abscess and remove dead tissue is often needed.

Outlook (Prognosis)

How well a person does depends on how severe the infection is. The death rate from undrained pancreatic abscesses is very high.

Possible Complications

Complications may include:

• Multiple abscesses
• Sepsis

When to Contact a Medical Professional

Call your health care provider if you have:

• Abdominal pain with fever
• Other signs of a pancreatic abscess, especially if you have recently had a pancreatic pseudocyst or pancreatitis

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. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 76.

Ferreira LE, Baron TH. Endoscopic treatment of pancreatic disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 61.

Forsmark CE. Pancreatitis.In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 135.

Van Buren G, Fisher WE. Acute and chronic pancreatitis. In: Kellerman RD, Rakel DP, eds. Conn's Current Therapy 2020. Philadelphia, PA: Elsevier 2020:167-174.