Acute pancreatitis: complications

Question 1

What are peripancreatic fluid collections?

Answer 1

Collections that occur in 25% of acute pancreatitis cases, located in or near the pancreas, lacking a wall of granulation or fibrous tissue. They may resolve or develop into pseudocysts or abscesses. Aspiration and drainage is best avoided as it may precipitate infection.

Question 2

What are pseudocysts in acute pancreatitis?

Answer 2

Pseudocysts result from the organization of peripancreatic fluid collections, typically occurring 4 weeks or more after an attack. They are walled by fibrous or granulation tissue and may or may not communicate with the ductal system. 75% are associated with persistent mild elevation of amylase.

Investigation is with CT, ERCP, MRI, or endoscopic USS. Symptomatic cases may be observed for 12 weeks as up to 50% resolve. Treatment options include endoscopic or surgical cystogastrostomy or aspiration.

Question 3

What is pancreatic necrosis?

Answer 3

Pancreatic necrosis involves both the pancreatic parenchyma and surrounding fat. Complications are linked to the extent of necrosis. Early necrosectomy has a high mortality rate and should be avoided unless compelling indications exist. Sterile necrosis should be managed conservatively.

Fine-needle aspiration sampling may be performed if infection is suspected, but false negatives may occur.

Question 4

What is a pancreatic abscess?

Answer 4

An intraabdominal collection of pus associated with the pancreas but in the absence of necrosis, typically occurring as a result of an infected pseudocyst. Treatment methods include transgastric drainage or endoscopic drainage.

Question 5

What is the significance of haemorrhage in acute pancreatitis?

Answer 5

Infected necrosis may involve vascular structures, leading to haemorrhage that can occur de novo or as a result of surgical necrosectomy. Retroperitoneal haemorrhage may present with Grey Turner’s sign.

Question 6

What is acute respiratory distress syndrome in the context of acute pancreatitis?

Answer 6

A systemic complication associated with a high mortality rate of around 20%.

Question 7

local and systemic complications of acute pancreatitis

Answer 7

local

• Peripancreatic fluid collections
• Pseudocysts
• Pancreatic necrosis
• Pancreatic abscess
• Haemorrhage

systemic
- acute respiratory disress syndrome