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  • • Acute pancreatitis that clinically fails to improve, worsens or improves transiently followed by worsening of signs and symptoms

    • Fever

    • Leukocytosis

    • CT scan showing pancreatic necrosis and fluid collection; sometimes gas bubbles

    • Percutaneous aspiration of pancreatic fluid showing organisms on Gram stain and culture


  • • Pancreatic abscess complicates about 5% of cases of acute pancreatitis and carries a high mortality

    • Develops in severe cases accompanied by hypovolemic shock and pancreatic necrosis and is an especially frequent complication of postoperative pancreatitis

    • Abscess formation follows secondary bacterial contamination of necrotic pancreatic debris and hemorrhagic exudates; the organisms may spread to the pancreas hematogenously as well as directly through the wall of the transverse colon

Symptoms and Signs

  • • Epigastric pain

    • Palpable tender mass

    • Fever

    • Jaundice (if biliary obstruction from inflammation)

Laboratory Findings

  • • Leukocytosis

    • Elevated bilirubin

    • Aspirated fluid collection

    • -Gram stain and culture demonstrating microbial organisms

Imaging Findings

  • Chest film: Pleural fluid and diaphragmatic paralysis

    CT scan: Fluid collection in the area of the pancreas; gas in the collection suggests infection

    • Percutaneous CT scan-guided aspiration: To obtain a specimen for Gram stain and culture

  • • An abscess should be suspected when a patient with severe acute pancreatitis does not improve and rising fever develops or when symptoms return after a period of recovery

    • Distinguishing uninfected pancreatic necrosis from infected abscess can be difficult

    • -CT findings and aspiration of fluid collection may aid in making the diagnosis

Rule Out

  • • Uninfected pancreatic necrosis, which may not require surgical treatment

  • • CBC

    • Abdominal CT scan with aspiration of fluid collection for Gram stain and culture

When to Admit

  • • All cases

  • • Percutaneous drainage is inadequate

    • Surgical drainage and debridement of necrotic pancreatic debris and external drainage is required



  • • All cases of infected pancreatic abscess

    • An indication for operation in sterile pancreatic necrosis is controversial


  • • Broad-spectrum antibiotics


  • • Postoperative hemorrhage (immediate or delayed)

    • Pancreatic fistula


  • • Mortality rate is 20%, a consequence of the severity of the condition, incomplete surgical drainage, and delayed diagnosis


  • • Controversial whether antibiotic administration in severe acute pancreatitis reduces risk of infected pancreatic abscess


Baril NB et al. Does an infected peripancreatic fluid collection or abscess mandate operation? Ann Surg. 2000;231:361.  [PubMed: 10714629]
Beger HG, Rau B, Isenmann ...

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