The danger of pancreatic abscess - is there any effective treatment?

Pancreatic abscess is a dangerous disease that develops against the background of acute inflammation of this organ and the accumulation of purulent contents in the resulting cavities in the tissue structures of the gland. In most cases, it begins to develop after an attack of acute pancreatitis, formed against the background of alcohol intoxication of the body. Untimely treatment of this pathology, in most cases, causes death in the patient. In this article, we will consider in more detail the causes of the development of pathology, its symptomatic signs of manifestation, diagnostic methods and ways to eliminate it.

General information

Purulent pancreatitis is a serious disease that develops from a combination of several etiological factors, leading to a diffuse purulent inflammatory process in the pancreatic tissue. Acute pancreatitis is the third most common surgical disease requiring emergency surgical care, after acute appendicitis and cholecystitis.

Among all types of acute inflammation of the pancreas, purulent pancreatitis occurs in every tenth patient. In general, the pathology affects 0.02-0.08% of the world's population annually, the vast majority of patients are men. The danger lies in the high risk of developing multiple organ failure and subsequent death if diagnosis and treatment are not started in a timely manner.

Doctors say that this form of inflammation is on the list of the most common diseases, being in third place after acute appendicitis and cholecystitis. If you trust the statistics, then such inflammation occurs in many men.

Acute pancreatitis today ranks third in the ranking of acute abdominal diseases requiring immediate treatment in a surgical hospital. The first place in this ranking is taken by acute appendicitis, and the second place by acute cholecystitis. According to world statistics, every year acute pancreatitis is detected in 200-800 people out of 1 million. Most often, this disease is detected in males.

Purulent pancreatitis occurs in 10-15% of cases of acute pancreatitis and is characterized by an extremely serious condition of the patient with a high risk of death. Basically, the disease occurs as an immediate reaction in response to various etiological factors, in particular, food intoxication, neurovascular disorders, etc.

In most cases, the clinical picture of purulent pancreatitis is a combination of several factors. By itself, an infection that has penetrated the pancreatic ducts cannot cause such a serious pathology. Typically, the inflammatory process develops against the background of a violation of the integrity of the pancreas - its glandular tissue, ducts and vessels.

ICD-10 code - K85 Acute pancreatitis

Pancreatitis statistics by causes

40% of all patients with inflammation of the pancreas are alcoholics. They most often exhibit either organ necrosis or destructive disorders.

30% of patients are patients with a history of gallstone disease.

20% of patients are obese patients.

5% of patients are patients who have suffered organ trauma or intoxication of the body and are taking medications.

Less than 5% of patients are patients who have a hereditary predisposition to the formation of inflammation, or suffer from congenital defects in organ development.

Causes of the disease

Doctors did not agree on a common opinion regarding the etiology of the pathological process.

The following predisposing or provoking factors are identified:

• bloodborne infection;
• puncture of false pancreatic cysts without observing the rules of asepsis;
• the formation of fistulas connecting the cavity of the gland cyst with the intestinal lumen;
• premature laparotomy, irrational antibacterial therapy;
• the addition of a secondary infection against the background of pancreatic necrosis (enterobacteria, Escherichia coli).

In the acute form of pancreatitis, the tissue of the organ is injured, and pancreatic enzymes aggressively affect the surrounding organs and the gland itself. Pseudocysts are formed - cavities of various sizes that are filled with dead tissue and inflammatory fluid.

If pathogenic microbes enter the source of inflammation, phlegmon (diffused purulent inflammation) of the pancreas is formed or an abscess is formed.

It should be noted that purulent pancreatitis of the pancreas is the most dangerous and prognostically unfavorable diagnosis. Therefore, the doctor who treats the patient, when characteristic complaints and symptoms appear, must exclude the development of an abscess or phlegmon.

Classification

Acute pancreatitis is characterized by a phase course and a variety of types of complications - pathological changes in the tissues of the pancreas and nearby organs.

Purulent

Purulent complications of pancreatitis develop due to the aggressive effect on the tissue of the pancreas and neighboring organs of pancreatic juice, blood and lymph, as well as the addition of a secondary infection to the inflammatory process. After a long inflammatory process affecting the pancreas, complications of this form of pancreatitis are diagnosed. Such advanced changes are irreversible and provoke necrosis.

There is a classification of types of complications, which are divided according to special characteristics. Purulent complications are diagnosed by the following symptoms:

• fabric filtration;
• increased heart rate and pulse;
• fever;
• heavy sweating.

These complications are manifested by the following diseases:

• pancreatic necrosis;
• abscesses;
• purulent spread beyond the cavities of the false cyst and the gastrointestinal tract.

In most cases, a purulent complication is indicated by culturing E. coli.

Early

Such reactions can accompany the acute form of the disease from the very beginning and greatly aggravate the patient’s situation.

Manifestations of early complications include:

• enzymatic peritonitis;
• jaundice;
• heart failure;
• pericarditis;
• mental and emotional disorders;
• bleeding and ulcers of the abdominal cavity;
• blood clot formation.

Late

Acute pancreatitis is classified by severity:

• mild pancreatitis occurs with minimal damage to organs and systems, is expressed mainly by interstitial edema of the gland, is easy to treat and has a favorable prognosis for a quick recovery;
• the severe form of acute pancreatitis is characterized by the development of pronounced disorders in organs and tissues, or local complications (tissue necrosis, infection, cysts, abscesses).

Severe form of acute pancreatitis may be accompanied by:

1. Necrectomy (removal of dead tissue).
2. Resection (removal of part of an organ). If removal of the head is necessary, pancreaticoduodenectomy is performed. If the tail and body are affected, distal resection is performed.
3. Total pancreatectomy.
4. Drainage of abscesses and cysts.

Why do abscesses occur due to inflammation of the pancreas?

The reasons why pus-filled cavities form in the pancreas have not yet been fully elucidated. Experts believe that the main factors for the development of an abscess can be:

1. Infection brought from outside;
2. Unprofessional puncture of the head of the pseudocyst;
3. The occurrence of a fistula located between the cyst and the intestine;
4. Incorrect treatment of the pancreas or stopping it too early.

According to statistics, in most cases, when pus is cultured from an abscess, bacteria and bacilli that cause an intestinal infection are identified.
If patients have pancreatic necrosis, there is a high probability of a secondary infection causing the development of a cavity with pus. They belong to the risk group and are examined especially carefully. Hypertension will lower your blood pressure to normal levels without chemicals or side effects! More details

As for the mechanism of formation of such a cavity, it is quite clear. After an acute attack, pancreatic tissue undergoes partial disintegration.

Unsplit enzymes affect the surface of the gland and surrounding organs, destroying it. This leads to the growth of pseudocysts or the development of pancreatic necrosis, which are the basis for the development of purulent cavities. If an infection penetrates into them, it either contributes to the development of large-scale purulent melting or provokes the occurrence of an abscess. According to the ICD classification system, phlegmon is a more severe disease with a poor prognosis, but clinically it is almost no different from an abscess expressed in a single cavity. Therefore, doctors should examine patients with suspected abscess as carefully as possible to exclude the presence of phlegmon.

Causes

For the development of purulent pancreatitis, infection in the pancreatic parenchyma alone is not enough, but a combination of several etiological factors is required. Gastroenterologists and abdominal surgeons include predisposing factors:

• abuse of fatty foods;
• long-term medication use;
• increased levels of toxins in the body;
• gallbladder disease;
• disease of the gastrointestinal tract;
• liver inflammation;
• pancreatic surgery;
• viral infections.

A favorable background can be diseases of the hepatobiliary system, leading to disruption of the outflow of bile:

• cholelithiasis, cholangitis, cysts, stenoses and tumors of the bile ducts (biliary pancreatitis);
• pancreatic injuries and cysts.

Against the background of the influence of these factors, pressure in the bile ducts increases, which contributes to the retrograde reflux of pancreatic juice into the pancreatic ducts.

This inflammation can develop as a consequence of acute pancreatitis or disruption of the integrity of the pancreas. Doctors strongly recommend not to neglect your health, since very often pancreatitis can lead to the death of the patient.

A favorable background can be diseases of the hepatobiliary system, leading to disruption of the outflow of bile: cholelithiasis, cholangitis, cysts, stenosis and tumors of the bile ducts (biliary pancreatitis); pancreatic injuries and cysts. Against the background of the influence of these factors, pressure in the bile ducts increases, which contributes to the retrograde reflux of pancreatic juice into the pancreatic ducts.

Pancreatitis in adults is a fairly common problem that anyone can encounter. Disorders associated with the outflow of bile, as well as dietary habits (for example, consumption of fatty and rich meat foods, stress, hereditary predisposition, alcohol, etc.) can lead to development. Consequently, those people who constantly abuse alcohol have a higher risk of developing pancreatitis.

According to statistics, it develops more often in pregnant women and young mothers during the postpartum period. The key to preventing the development of pancreatitis is the correct approach to the formation of a diet.

Reasons and factors

Diffuse purulent inflammation of the pancreas is a disease localized in the tissues of the organ, requiring immediate surgical intervention. According to statistics, 10 out of 100 patients develop acute purulent form of pancreatitis. Representatives of the stronger sex are at risk. The danger lies in a high percentage of complications and even death if the diagnosis is made incorrectly or late.

Doctors have proven that the purulent form of pancreatic disease is formed not only due to infection, and more precisely, this is not enough. This is caused by a combination of several unfavorable factors, against the background of which an infection results in such a serious disorder and a purulent focus.

Associated ailments that lead to purulent inflammation include:

1. Bad habits, in particular alcohol and smoking abuse.
2. Unbalanced diet, lack of regular eating regimen.
3. Potent drugs. As they say, one is treated, another is crippled.
4. Damage to the pancreas and cysts.

The most significant pathologies also include diseases of the body system responsible for the formation and removal of bile: duct tumors, stenoses, cholangitis, cholelithiasis, etc.

Untimely synthesis of food enzymes and malfunction of blood vessels play a leading role in infection of the organ. Enzymes literally corrode tissues, that is, they give rise to an aseptic inflammatory process. Arrosion of small vessels provokes frequent hemorrhages. When there is a focus with a chronic infection, for example, cholangitis, appendicitis, a viral disease, cholecystitis, etc., the bacteria are carried through the blood along the bile ducts and lymphatic vessels, thus entering the gland and infecting it.

Unlike a gland abscess, purulent pancreatitis is characterized by a diffuse nature of organ damage and many inflammatory foci. A large number of microabscesses are formed, which over time develop into cavities with pus, the opening of which carries the risk of pus entering the peritoneum and bloodstream, which will inevitably result in an increase in the affected area, affecting adjacent systems and organs. Poisoning of the body occurs, disruptions in the functionality of vital processes and, as a result, multiple organ failure.

Timely recognition of the disease is the key to successful recovery. In an advanced form, including with a cumulative failure of systems, death is possible.

Pathogenesis

The pathogenesis is based on vascular disorders and premature activation of pancreatic enzymes. Own enzymes melt the pancreatic tissue, causing aseptic inflammation. Due to erosion of the walls of small vessels of the organ, multiple hemorrhages occur in the parenchyma (hemorrhagic pancreatitis). In the presence of a focus of chronic infection (cholecystitis, cholangitis, appendicitis, severe bacterial or viral diseases, etc.), bacteria enter the gland tissue through the bile ducts, through the bloodstream or through the lymphatic vessels, causing its infection.

Most often, the inflammatory process takes on a diffuse nature; against its background, many microabscesses are formed, which over time merge into large purulent cavities. When an abscess is opened, pus can enter the abdominal cavity and bloodstream, leading to the spread of inflammation to other organs and systems. Purulent pancreatitis, in contrast to pancreatic abscess, is characterized by diffuse inflammation and many purulent foci.

The entry of pus, breakdown products and pancreatic enzymes into the bloodstream and abdominal cavity leads to significant intoxication, disruption of vital internal organs and ultimately to multiple organ failure. If purulent pancreatitis is not recognized before this stage and intensive pathogenetic therapy is not started, damage to internal organs may become irreversible, resulting in death.

Pancreatic abscess

A pancreatic abscess is the formation of pus and necrotic masses in the pancreatic cavity. Very often, an abscess develops after acute alcoholic pancreatitis. The disease is characterized by fever, the appearance of girdle pain, and leukocytosis.

After about two weeks, after an attack of pancreatitis, a tumor-like formation forms in the abdominal cavity. The diagnosis of pancreatic abscess can be established by ultrasound, MRI, CT scan of the abdominal cavity, and blood tests.

The only effective treatment for pancreatic abscess is surgical debridement of the abscess followed by antibiotic therapy.

Pancreatic abscess is a very serious disease that develops in patients who have suffered pancreatitis, pancreatic necrosis with the formation of a purulent cavity in the gland.

An abscess can form with any form of pancreatitis, but only except edematous; 2-5% of cases of this disease end in the formation of an abscess. Very often, a pancreatic abscess develops against the background of alcoholic pancreatitis.

The disease is very dangerous for the patient's life. In modern gastroenterology, antibiotics are prescribed for pancreatitis only in cases of damage to the biliary tract or proven bacterial complications. Cases of fever and abdominal pain within fourteen days after pancreatitis should be considered as a probable pancreatic abscess.

The treatment method that leads to the patient’s recovery is surgery to drain the abscess. Without surgery, the mortality rate for this pathology is very high, and it reaches almost one hundred percent.

Pancreatic abscess and its causes

The reasons for the formation of a purulent cavity in the pancreas have not yet been fully elucidated. There are suggestions that the infection can be introduced through the bloodstream, when pseudocysts are punctured, or during the formation of a fistula between the cyst and the intestines.

In the vast majority of cases, during aspiration and culture of the abscess contents, E. coli or enterobacteria are isolated. According to research in the field of gastroenterology, the addition of a secondary infection is observed in almost sixty percent of cases of pancreatic necrosis, therefore, when treating this disease, the likelihood of the formation of a cavity with purulent contents should be taken into account.

The mechanism of formation of a purulent cavity itself has been studied much better. At the onset of acute pancreatitis, the gland tissue is damaged, causing enzymes to reach both the gland itself and the surrounding tissues, destroying them. Because of this, pancreatic necrosis can begin, and pseudocysts are formed - cavities filled with liquid contents and necrotic tissue.

When an infection enters the area of ​​the pathological process, either phlegmon of the pancreas develops - total purulent melting, or an abscess forms. It should be noted that phlegmon is a more severe and prognostically unfavorable condition, clinically practically no different from a single abscess.

The formation of pancreatic abscess is promoted by severe pancreatitis with several risk factors: postoperative pancreatitis, early laparotomy, early start of enteral nutrition, irrational antibiotic therapy.

Pancreatic abscess and its symptoms

For some time, up to 30 days, from the onset of pancreatitis, the temperature rises to febrile levels, chills, tachycardia appear, and pain in the upper half of the abdominal cavity intensifies. The pain is girdling in nature and quite severe.

The patient notices weakness, fatigue, lack of appetite, increased sweating, nausea, vomiting with a feeling of bitterness in the mouth.

On palpation of the abdominal cavity, the presence of a tumor-like formation and tension in the muscles of the anterior abdominal wall are felt.

Pancreatic abscess is often complicated by further spread of infection, the formation of multiple abscesses in the gland itself and the surrounding organs. Pus can flow retroperitoneally, break into hollow organs, subphrenic and pericardial tissue, pleural and pericardial cavities, and therefore an intestinal abscess, subdiaphragmatic abscess, purulent pleurisy and pericarditis can form.

Diagnosis of pancreatic abscess

The diagnosis is made only after a very thorough examination of the patient. A general blood test reveals high leukocytosis, a shift in the leukocyte count to the left, an increase in ESR, and anemia. In a biochemical blood test, attention is drawn to an increase in the level of pancreatic enzymes and hyperglycemia.

The level of urine amylase is increased, although when an abscess forms, its amount may gradually decrease.

X-ray examination of a pancreatic abscess has some features. Since the gland is located behind the stomach, the shadow of the abscess cavity can overlap the gas bubble of the stomach.

Therefore, the exposure should be longer, and if an abscess is suspected, a contrast agent is injected into the stomach cavity and a vertical photograph is taken in a lateral projection - in this case, a rounded shadow with a fluid border (abscess) will be located behind the stomach.

Ultrasound of the pancreas and CT scan of the abdominal organs will help determine the location and size of the lesion and the number of abscesses. If necessary, simultaneous percutaneous puncture with aspiration, examination and culture of the contents is possible. Differential diagnosis is carried out with pancreatic pseudocyst, pancreatic necrosis.

Treatment of pancreatic abscess

A surgeon and an endoscopist must treat a pancreatic abscess. A pancreatic abscess is an absolute indication for its sanitation and drainage.

Experience shows that percutaneous drainage of ulcers leads to cure only in forty percent of cases; moreover, with such tactics, phlegmon, multiple abscesses, and the spread of infection to the tissue surrounding the pancreas can be missed. That is why endoscopic or classic laparotomic excision and drainage of the abscess will be the best option.

In parallel, the patient is prescribed antibacterial therapy according to the cultures obtained, painkillers, antispasmodics, and enzyme inhibitors. Infusion therapy is carried out for detoxification.

Since the reasons for the formation of abscesses in the pancreas are not fully understood, today there are no measures to prevent the development of this pathology after pancreatitis and pancreatic necrosis.

Thus, the prevention of abscess formation is the prevention of pancreatitis - after all, an abscess can form only against its background.

The prognosis for the formation of abscesses is serious: without surgical treatment, the mortality rate is one hundred percent, and after surgery the survival rate is 39-59%. The prognosis of the disease depends on timely treatment, rapid diagnosis and surgical treatment.

Symptoms of purulent pancreatitis

From the onset of the disease to the appearance of a clear clinical picture of pancreatitis, it can take several days or several weeks. Usually the first clinical sign is pancreatic colic - the occurrence of acute girdle pain in the upper abdomen. The pain radiates to the back, shoulder blades, and behind the sternum. The intensity of the pain can be so severe that it sometimes leads to loss of consciousness. Often the pain is accompanied by persistent vomiting, which does not bring relief to the patient, and occurs even after a sip of water.

Vomiting provokes an increase in intra-abdominal pressure, causing pancreatic juices to reflux into the pancreas, which causes the intensity of pain after vomiting to increase even more. The patient often takes a forced position on his side with his knees pulled up to his chest. Due to disruption of the pancreas, symptoms of dyspepsia develop: nausea, belching, increased flatulence, diarrhea. The stool is liquid and contains undigested food particles and fats. The combination of severe dyspeptic, pain and intoxication syndromes leads to anxiety, tearfulness, and sometimes to the development of pancreatogenic psychosis.

As the process progresses, dynamic intestinal obstruction occurs, manifested by significant bloating and vomiting of stagnant contents. On palpation of the abdomen, sharp pain is noted in the upper half, and symptoms of peritoneal irritation may appear. Cyanotic spots appear on the skin of the anterior abdominal wall, and swelling of the fatty tissue in the lumbar region is noticeable. At the first stages of the development of the disease, the body temperature is subfebrile, but after the addition of infection and diffuse inflammatory process, significant hyperthermia is noted.

Often the development of this disease can hide its process from several days to a week. Sometimes it happens that inflammation can occur secretly and manifests its symptoms only after a couple of weeks.

The main symptom of purulent inflammation is an acute girdling pain in the upper abdomen; the patient may also feel painful impulses in the back and subscapular region. The pain may be accompanied by such a strong spasm that a person may lose consciousness from it.

Also common symptoms of the disease are:

• rapid weight loss;
• vomiting (can occur even after a small sip of water);
• diarrhea;
• increased heart rate;
• chills;
• elevated body temperature.

The patient may complain about the disease, even if it does not cause any pain syndromes, since this inflammation is very physically exhausting. Any movement or cough can cause severe pain to return.

As a consequence of the disease, dark or burgundy spots on the skin may appear, which are found in the navel or abdomen.

Acute purulent pancreatitis

Purulent pancreatitis can occur in an acute form - this is the most severe form of the disease, which is observed quite rarely, in only 10-15% of patients. A distinctive feature of acute purulent pancreatitis is its extremely high mortality rate.

Acute purulent pancreatitis in most cases develops as a result of neurovascular disorders or food poisoning. In isolated cases, the underlying causes of the disease were syphilis, typhus or mumps. The disease occurs against a background of severe, debilitating pain in the upper abdomen, often leading to shock and collapse. During painful shock, a person’s face becomes ashen-gray, and the pulse is practically not palpable. In addition, the attack is accompanied by bloating, nausea and vomiting. At the same time, tension in the abdominal muscles is felt.

Many medical experts agree that the development of acute purulent pancreatitis is provoked by several pathogenic factors. Penetration of infection is not the only reason; the presence of an appropriate environment is important: damaged vessels, glandular tissue, ducts. Activation of lipase and trypsin leads to circulatory disorders. Other factors include stomach disease, unhealthy diet, and pancreatic injury.

Disease prevention measures

Pancreatic abscess, although not a fatal disease (if you contact a doctor in a timely manner), is very dangerous and serious. Why expose yourself to the danger of its occurrence if the disease can be prevented? Moreover, preventive measures are not of any special nature. It is enough to lead a healthy lifestyle, namely, do not abuse alcohol-containing drinks, limit your consumption of fried and fatty foods, eat more vegetables and fruits, following Diet No. 15, walk in the fresh air and do simple physical exercises.

An abscess is considered an extremely serious disease that can develop in people who have had or are suffering from pancreatic pathology. In fact, this is a life-threatening abscess that rarely responds to initial treatment with antibiotics.

Experts say that most often an abscess appears in people suffering from alcoholic gland disease in any form. The only way to save the patient in this case is urgent surgery.

Complications

The toxic effect of pancreatic enzymes on the bone marrow is manifested by severe thrombocytopenia and anemia. As a result of purulent melting of the tissues of the pancreas and surrounding organs, fistulas, enzymatic peritonitis, and purulent pleurisy can form; arrosion of large vessels leads to profuse bleeding; As a result of the inflammatory process, thrombosis and thrombophlebitis of the veins of the porto-caval system occur. It is possible to form a septic process in which purulent pancreatitis serves as the primary focus.

Severe intoxication leads to heart damage - constant tachycardia and arterial hypotension are noted.

Toxic myocarditis causes the development of severe circulatory failure. Lung damage may be accompanied by respiratory distress syndrome and respiratory failure. Progressive multiple organ failure can ultimately lead to death.

Abscess treatment

If a gastroenterologist or therapist treats a patient with inflammation and swelling of the pancreas, then surgeons and endoscopists deal with patients with its suppurations. They carry out sanitation of cavities and their drainage.

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In some cases, partial drainage through the skin is done, but it is effective and leads to complete cure only in half of the cases.

In addition, this method of cleansing the cavity from pus does not make it possible to detect phlegmon or the presence of multiple abscesses.

Therefore, surgical excision followed by drainage is considered the best treatment option. It allows doctors to carefully examine the gland and surrounding organs to identify cellulitis and secondary abscesses.

After surgery, patients are prescribed antibiotics, painkillers, and drugs that help the gland break down enzymes and reduce their activity.

Diagnostics

Diagnosis may be difficult if the patient seeks medical attention after developing complications. The examination should be carried out in a hospital setting, in case of moderate purulent pancreatitis - in the department of gastroenterology or general surgery, in case of severe condition of the patient - in the intensive care unit.

A visual inspection can already partially clarify the picture. For example, cyanotic spots often appear on the skin of the anterior abdominal wall, and swelling of the fatty tissue is visible in the lumbar area. Palpation of the upper abdomen is likely to cause pain - a sure sign of irritation of the peritoneal area.

If the day before the patient drank alcohol or indulged in spicy, smoked or fried foods in excess, then he is urgently sent for a survey x-ray of the peritoneum. It would not be superfluous to conduct an MRI of the pancreas, as well as ultrasonography of the biliary tract and the gland itself.

The result of the above-described manipulations will be the understanding that there is effusion in the omental bursa, an increase in the size of the organ, swelling and the presence of purulent foci inside the cavity.

RCCP or retrograde cholangiopancreatography is performed with extreme caution, due to the risk of necrosis of the pancreas, wholly or partially due to self-digestion. You cannot do without research on the level of enzymes in urine and blood serum. If the doctor suspects pancreatic necrosis, biliary hypertension or worsening pancreatic disease, the patient will be sent for laparoscopy.

Such complex diagnostic methods as esophagogastroduodenoscopy and multislice computed tomography of the abdominal organs are used if it is difficult to make a diagnosis. Purulent pancreatitis is similar to a perforated gastric ulcer or duodenal ulcer, cholecystitis, intestinal obstruction, appendicitis, thromboembolism of mesenteric vessels, etc. If the doctor has any doubts, MSCT and endoscopy will finally dot the i’s.

When carrying out the above studies, an increase in the size of the organ due to edema, the formation of many purulent cavities, edema and inflammatory infiltration of the retroperitoneal tissue around the gland will be detected. An effusion may be visible in the omental bursa. The appointment of retrograde cholangiopancreatography must be approached very carefully - this procedure can lead to the development of pancreatic necrosis. RCCP is performed only to exclude blockage of the common bile duct with stones, as a cause of purulent pancreatitis, or after stabilization of the patient's condition. According to indications, esophagogastroduodenoscopy and MSCT of the abdominal organs are prescribed.

Dynamic studies are required to determine the level of pancreatic enzymes in the blood and urine. If there are difficulties in diagnosis, diagnostic laparoscopy is recommended. Indications for this operation are the development of pancreatitis, hypertension in the biliary tract, and suspected pancreatic necrosis.

Purulent pancreatitis should be differentiated from other acute surgical pathologies: cholecystitis, appendicitis, perforated gastric and duodenal ulcers, intestinal obstruction, thromboembolism of mesenteric vessels.

Treatment of purulent pancreatitis

Therapy is recommended to be carried out in an abdominal surgery or intensive care unit. Conservative treatment requires adherence to the principle of “cold, hunger and rest” - it is this that guarantees the subsidence of the inflammatory process and the effectiveness of conservative therapy for this disease. Therapeutic fasting leads to inhibition of the production of pancreatic enzymes and relief of pain. It is also recommended to apply an ice pack to the upper abdomen to reduce the intensity of pain. Bed rest is required, as patients are in a state of severe intoxication.

High-volume infusion therapy is carried out in combination with forced diuresis to remove toxins from the bloodstream, reduce the level of pancreatic enzymes, and reduce swelling of the organ. Infusion therapy necessarily includes inhibitors of proteolytic enzymes (aprotinin), and when glucose levels decrease due to the destruction of pancreatic tissue, concentrated solutions of sugars. To correct water and electrolyte disturbances, the introduction of solutions of salts, calcium, and magnesium is required.

Severe pain during purulent pancreatitis is caused not only by enzymatic melting of organ tissue, but also by compression of the edematous pancreas by its dense capsule. Antispasmodics and narcotic analgesics are prescribed for pain relief. The use of antibiotics is mandatory in treatment. With the development of multiple organ failure, glucocorticoids, cardiotropic drugs, and other drugs are prescribed to correct the vital functions of the body.

The presence of a diffuse inflammatory process in the pancreas requires surgical treatment. According to indications, laparoscopic cholecystectomy and dissection of the pancreatic capsule with drainage of abscesses are performed. In severe cases, extensive surgical intervention is used - necrectomy of the pancreas, drainage of the abdominal cavity.

Doctors advise applying ice to the upper abdomen, which will help get rid of pain and some symptoms.

In mild cases of inflammation, the patient is prescribed IVs containing drugs with analgesic and diuretic properties to reduce swelling.

In severe cases of inflammation, doctors recommend immediate surgical intervention, which will not only protect the body from further complications, but also prevent the possibility of death.

A contraindication to surgery for purulent pancreatitis may be the patient’s severe condition, which can interfere with surgical intervention and cause the patient’s death.

Modern clinics are universally abandoning extensive surgical intervention and are increasingly giving preference to optimal surgical methods. Today this method is laparotomy. This method allows you to penetrate through small holes into the abdominal cavity without cutting it completely, and through them remove the causes of inflammation.

Treatment

Surgical intervention (unadvanced cases are treated with gentle surgery - laparoscopy) followed by antibiotic therapy. Refusal of surgical intervention guarantees death. Before the operation, medications are taken that correct (suppress) the production of enzymes.

Subsequent adherence to the diet is mandatory. Excluded from the diet:

• any smoked meats;
• products containing animal fat and vegetable oil are strictly dosed;
• fried foods are strictly prohibited, the same goes for rich broths;
• bakery products (except dry bread);
• You will have to forget about alcohol and coffee for a long period.

For diseases of the pancreas, patients are prescribed the “Table No. 5” diet. Many years of experience in the use of this diet, including by Soviet nutritionists, have made it possible to prove its effectiveness and necessity during rehabilitation and restorative therapy for pancreatic abscess.

Purulent pancreatitis of the pancreas after surgery

Prescription of drug therapy is often carried out during the consultation. A number of specialists take part in the discussion - a gastroenterologist, a surgeon, an endoscopist and other doctors. Surgical intervention is used for diffuse inflammatory process of a parenchymal organ. Surgery consists of draining purulent cavities. If necessary, necrotic areas of the gland are removed with drainage of the peritoneum.

In order to prevent purulent pancreatitis from appearing, a number of preventive measures are taken after the operation, the main component of which is considered to be antibacterial treatment. An equally important stage of therapy is fasting and subsequent adherence to a special diet. The diet must be low-calorie, and food is consumed in small portions, but often (5-8 times a day).

In order for recovery to occur more quickly, the patient must drink a sufficient amount of non-carbonated mineral water - 2 liters per day. It is allowed to drink green tea, infusions of rose hips, and chamomile. Certain experts advise their patients to drink a special pancreatic drink. Alcoholic drinks and coffee are prohibited. Purulent pancreatitis is considered a serious disease, which is accompanied by a number of life-threatening complications.

For this reason, even intensive therapy does not carry favorable prognoses. Because of this, after the operation the patient undergoes a long recovery and periodically consults with a gastroenterologist. A number of other important recommendations can prevent the formation of purulent pancreatitis:

1. Completely give up cigarettes and alcoholic drinks.
2. Balanced diet.
3. Limit the use of potent drugs in high dosages.

Compliance with preventive measures will help prevent the occurrence of purulent processes in the gland. Thus, you should more carefully monitor your own well-being and promptly treat diseases of the liver, digestive organs and gall bladder.

Diet for the purulent stage of pancreatitis

This form of inflammation, like the mild stage of pancreatitis, requires, first of all, a strict diet, that is, a balanced diet and avoidance of alcoholic beverages.

Meals should be low-calorie, but frequent - about 5-6 times a day. Also, during the acute stage of pancreatic inflammation, doctors force the patient to completely stop eating for a short period of time. This will not only speed up the treatment of the patient, but will also prevent further complications.

Water consumption also plays an important part in the patient’s diet. The patient should drink his daily water intake - from 1.5 to 2 liters. The water should be mineral and still. As for teas, you are allowed to drink green tea or various herbal infusions (rose hips, chamomile). You should give up coffee for a long time.

The diet of a patient with pancreatitis should include non-acidic vegetables, which can be taken raw or boiled. It is also allowed to make non-acidic juices from them.

Also, to maintain your health, you should avoid flour products, foods high in sugar, fatty foods, and very hot or very cold foods.