What are the complications of pancreatitis?
Complications of pancreatitis can be conceptualized as occurring in two domains one as local and one as systemic complications. Local complications of acute pancreatitis include necrosis, pseudocyst (fluid collection), abscess, ileus, fistulazation, GI hemorrhage, phlegmon and pseudoaneurysm. Distant or systemic complications include shock, respiratory failure, metabolic derangements such as hypocalcemia, hyperglycaemia, coagulopathy and disseminated intravascular
coagulation. Some of the complications from pancreatitis are: low blood pressure, heart failure, kidney failure, ARDS (adult respiratory distress syndrome), diabetes, ascites, accumulation of fluid in the abdomen, and cysts or abscesses in the pancreas.
In mild acute pancreatitis there are few complications, although it is fatal in a minority of cases (<5% patients). Severe acute pancreatitis is fatal in 10-15% of cases, and 70% in those who develop infected pancreatic necrosis! Complications of severe acute pancreatitis are either generalised (e.g. lung or kidney failure, circulatory collapse) or localised (e.g. pancreatic necrosis, development of cysts within the pancreas, development of fistulas - abnormal communications between the pancreas and the skin or other organs). These complications require treatment by surgery or endoscopy (i.e. from within the digestive tract).
Severe cases of acute pancreatitis may lead to a number of complications. A damaged pancreas may become infected with bacteria that spread from the small intestine into the pancreas. Signs of infection include fever, an elevated white blood cell count and organ failure. A fluid sample from the pancreas may be tested for bacterial infection. If the tests are positive, you'll receive antibiotics. Some people also need surgery to drain or remove infected areas of the pancreas. Sometimes multiple operations are necessary. Cyst-like blisters called pseudocysts may form on and extend from the pancreas after an attack of acute pancreatitis. If the cyst is small, no special treatment is necessary. If it's large, becomes infected or causes bleeding, you'll need treatment. The doctor may drain the cyst through a catheter, or you may need surgery to drain or remove the cyst. Abscess is a collection of pus in or near the pancreas that can develop 4 to 6 weeks after the onset of acute pancreatitis. Treatment involves drainage of the abscess by catheter or surgery.
The main general complications of chronic pancreatitis are diabetes mellitus and fat malabsorption. Other localised complications include pancreatic cyst formation, narrowing of the duct that drains the gallbladder (resulting in jaundice), obstruction of the upper small intestine (rarely), or bleeding within the stomach and intestine. These complications generally require surgical or endoscopic treatment. |
