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Necrotising pancreatitis (pancreatic necrosis) is an aggressive form of acute pancreatitis. Pancreatic necrosis may lead to the development of sepsis, gastrointestinal bleeding, or symptoms of acute respiratory distress syndrome, with consequent death. What are the causes and symptoms of pancreatic necrosis? How is her treatment going?

Necrotising pancreatitis (pancreatic necrosis)is an aggressive formacute pancreatitis . In the course of this disease, the pancreas and surrounding tissues are self-digested by pancreatic enzymes. Then this organ becomes inflamed. If the mechanisms limiting the spread of the inflammatory process fail within the first hours, necrosis of the pancreatic tissues - the parenchyma and / or the peripancreatic tissues.

Pancreatic necrosis occurs in about 20 percent. cases of acute inflammation of this organ. Mortality in this group of patients is high and amounts to as much as 50%. In the remaining 80 percent. In cases of acute pancreatitis, a mild - edematous form develops.

Necrotising pancreatitis (pancreatic necrosis) - causes

The most common indirect (80% of cases) causes of necrotizing acute pancreatitis are diseases of the gallbladder and biliary tract (mainly gallstones) and alcohol abuse. In 10 percent the causes of inflammation are unknown. In the remaining 10 percent. the development of inflammation can lead to, among others :

  • abdominal trauma
  • hyperparathyroidism
  • anatomical abnormalities (bisectal pancreas) and medications (e.g. azathioprine, corticosteroids, thiazides)

Necrotising acute pancreatitis can also be a complication after examinations, e.g. after ERCP (endoscopic retrograde cholangiopancreatography) or after surgery, e.g. after gallbladder surgery.

Necrotising pancreatitis (pancreatic necrosis) - symptoms

Pancreatic necrosis symptoms vary and depend on many factors, including whether the disease process also affects other organs or only the pancreas, whether only the pancreas itself or the surrounding tissue is involved, whether there were local complications (e.g. pancreatic cysts) and whether the necrosis was infected(it occurs in about 1/3 of patients, most often after 10 days of illness). Then, in addition to the symptoms of acute pancreatitis, the following symptoms may also appear:

  • severe sepsis;
  • gastrointestinal bleeding;
  • acute respiratory distress syndrome;
  • of the generalized inflammatory reaction syndrome;
  • disseminated intravascular coagulation;

Necrotising pancreatitis (pancreatic necrosis) - diagnosis

Blood and urine tests are performed first. Characteristic is the increase in the activity of pancreatic enzymes - mainly lipase in the blood and amylase in the blood and urine. Another examination is an ultrasound of the abdominal cavity (during the examination you can see enlargement, swelling of the pancreas, blurring of its borders). The final diagnosis is made on the basis of the abdominal tomography with contrast medium. During the examination, the presence of tissue necrosis, pancreatic parenchyma or peripancreatic tissues is found.

Necrotising pancreatitis (pancreatic necrosis) - treatment

The electrolyte deficiencies are first corrected. In addition, the patient is nourished enterally using an enteral probe.

Antibiotics are also given to prevent infections. In the case of an already existing infection, antibiotic therapy is, in addition to surgery, a necessary auxiliary treatment.

The indication for surgical treatment in pancreatic necrosis is the patient's deteriorating condition, not the mere fact of finding necrosis. The exception is when pancreatic necrosis infection has been diagnosed. Surgery should also be considered when uninfected necrosis covers more than 50%. pancreatic parenchyma and the patient remains serious despite treatment. During the operation, pancreatic necrotic lesions, necrosis of peripancreatic tissues and fluid from the peritoneal cavity are removed.

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Category:

Gastrology