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Complications Of Acute Pancreatitis

Pancreatitis is a fairly uncommon disease. Acute pancreatitis is a condition that occurs suddenly. The associated pain is severe but patient recovery after the attack is complete. The attacks are discrete episodes with marked elevations of serum pancreatic enzymes. These indications are evident in the blood and urine tests due to the inflammatory process in the pancreas. Other symptoms observed are nausea, vomiting, respiratory failure, moderate fever and confusion. Alcohol abuse, gallstones, pancreas divisum (a congenital anomaly), microlithiasis and metabolic hypercalcemia and hyperlipidemia are all associated to the causes of acute pancreatitis. The complications of the disease is either systemic or locoregional. Majority of the patients (80%) recover without any sequelae. However, 20% of the patients suffer from severe acute pancreatitis and can develop regional as well as systemic complications.

Complications of acute pancreatitis

Pseudocysts:

A common complication of acute pancreatitis

  • Sacs filled with pancreatic fluid that can develop anywhere in the body (most common in the abdomen)
  • It takes at least 4 weeks to grow after an attack of acute pancreatitis
  • Palpable on physical examination
  • Detected on abdominal ultrasonography or CT scan
  • Causes bloating, indigestion and dull abdominal pain
  • They can also be small and may reveal no symptoms
  • Large pseudocysts are at a risk of rupture with internal bleeding, triggering an infection
  • Large long standing pseudocysts usually need some form of intervention.
  • In certain cases, they can be tackled endoscopically
  • If the location of the pseudocyst is not favourable for endoscopic treatment, surgery is needed.
  • Laparoscopic decompression of the cyst is often possible with minimal morbidity to the patient

Infected pancreatic necrosis:

  • Intra-abdominal infection due to acute pancreatitis is fairly common and a serious complication; fatal if left untreated
  • Fluid collections (pancreatic necrosis) are infected within the first 3 weeks after the attack of acute pancreatitis
  • Pancreatic abscess develops due to infected pseudocysts
  • High inflammations cause interruption to blood supply to the pancreas leading to necrosis or death of tissue
  • Symptoms are abdominal pain and high fever
  • Risk of systemic septic complications due to the spread of infection in to the blood causing multiorgan failure
  • Antibiotic injections are also prescribed as part of the treatment
  • Dead tissue is drained away with a catheter through the skin or laparoscopic surgery may be performed to wash away the tissue

These patients are usually very sick and might require multiple procedures. The recent trend is to do a minimal procedure first with the help of the radiologist and when the patient condition becomes better after partial removal of the infection, then do a laparoscopic or any other minimally invasive procedure.

Dr. Deepak Varma Treats the whole spectrum of complications of acute pancreatitis with total harmony with other specializations like radiology and endoscopy. He his well-versed with different minimally invasive procedures for complications of acute pancreatitis.