Pancreatic infection of devitalized retroperitoneal tissue is usually caused by gram-negative organisms. Infection should be suspected if the patient maintains a generally toxic appearance with elevated temperature and WBC count or if deterioration follows an initial period of stabilization. Percutaneous aspiration of pancreatic exudate guided by abdominal CT may reveal organisms on Gram stain or culture, which should lead to prompt surgical debridement. A pancreatic pseudocyst is a collection of enzyme-rich pancreatic fluid and tissue debris arising within areas of necrosis or an obstructed smaller duct. It is not surrounded by a true capsule.
Death is caused by secondary infection, hemorrhage, or rupture.
Diagnosis Acute pancreatitis should be considered in the differential diagnosis of every acute abdomen. The differential diagnosis of acute pancreatitis includes a perforated gastric or duodenal ulcer, mesenteric infarction, strangulating intestinal obstruction, ectopic pregnancy, dissecting aneurysm, biliary colic, appendicitis, diverticulitis, inferior wall MI, and hematoma of abdominal muscles or spleen. Laboratory tests cannot confirm a diagnosis of acute pancreatitis but can support the clinical impression. Serum amylase and lipase concentrations increase on the first day of acute pancreatitis and return to normal in 3 to 7 days. Both may remain normal if destruction of acinar tissue during previous episodes precludes release of sufficient amounts of enzymes to raise serum levels.