Complications

Definition: necrosis of pancreatic and peripancreatic tissue

Clinical features: fever, persistent tachycardia, or insufficient symptomatic improvement over several days

Diagnostics: nonenhancing areas of pancreatic parenchyma on CECT abdomen

Treatment

• Sterile necrotizing pancreatitis can usually be managed conservatively.

• Encourage enteral nutrition if feasible.

• Provide supplemental nutritional support as needed.

Definition: bacterial superinfection of necrotic pancreatic parenchyma

Clinical features: similar to those of necrotizing pancreatitis

Diagnostics

• Laboratory studies: persistent or worsening leukocytosis, bacteremia, increasing inflammatory markers

• CECT abdomen: gas within the pancreas and/or peripancreatic tissue or fluid collections

• Fine-needle aspiration of necrotic areas: not routinely recommended Treatment

• Broad-spectrum empiric antibiotics with good tissue penetration (e.g., carbapenems) for 4 weeks

• Drainage of infected material if there is clinical deterioration or persistence of symptoms despite antibiotic therapy

Prognosis: high mortality rate (30%

Definition

• An encapsulated collection of sterile necrotic material, usually occurring > 4 weeks after the onset of necrotizing pancreatitis

• Previously known as pancreatic abscess

Diagnostics: CT abdomen with IV contrast showing an encapsulated heterogeneous collection containing fluid and debris

Treatment (of symptomatic walled-off necrosis): percutaneous drainage or transmural endoscopic necrosectomy

Pancreatic pseudocyst

Abdominal compartment syndrome

Pancreatic hemorrhage (blood vessel erosion with bleeding)

Shock, SIRS, sepsis, DIC

Pneumonia, respiratory failure, ARDS

Pleural effusion

Prerenal failure due to volume depletion

Hypocalcemia

Paralytic ileus

Pancreatic ascites