Pancreas abscess – education in fabric of gland of the cavity filled with pus and necrotic masses. In most cases abscess develops after sharp alcoholic pancreatitis. The leykotsitoza, opukholevidny education in an abdominal cavity approximately in two weeks after a pancreatitis attack is characterized by emergence of fever, the surrounding pains. The diagnosis is established after performing ultrasonography, MPT or KT of an abdominal cavity, the analysis of biochemical and all-clinical parameters of blood. The only effective method of treatment – surgical sanitation of abscess with the subsequent antibacterial therapy.
Pancreas abscess – the hardest disease which develops at the patients who had pancreatitis (sharply or a repeated aggravation) or with formation in iron of the delimited purulent cavity. Abscess can be created at any form of pancreatitis, except edematous; 3-4% of cases of this disease come to an end with formation of abscess. Most often develops against the background of alcoholic pancreatitis. The disease is life-threatening the patient, and his insidiousness is covered in a styortost of clinic against the background of antibiotic treatment. For this reason in modern gastroenterology it is accepted to appoint antibiotics at pancreatitis only at the accompanying defeat of bilious ways or the proved bacterial complications. All cases of temperature increase and emergence of belly-aches within two weeks after pancreatitis have to be considered as probable pancreatic abscess. The only method of treatment leading to recovery – surgery on drainage of an abscess. Without operation the lethality at this pathology reaches 100%.
Pancreas abscess reasons
The reasons of formation of a purulent cavity in a pancreas are up to the end not clear. It is supposed that the infection can be brought by blood current, at a puncture of pseudo-cysts (if the asepsis is not observed), when forming fistula of a cyst with intestines. In most cases at aspiration and crops of contents of an abscess colibacillus or enterobakteriya is emitted. According to researches in the field of gastroenterology, accession of a secondary infection is observed practically in 60% of cases of a pankreonekroz therefore at treatment of this disease it is necessary to consider probability of formation of a cavity with purulent contents.
The mechanism of formation of a purulent cavity is studied better. At the beginning of sharp pancreatitis fabric of gland is damaged because of what enzymes get also on gland, and on surrounding fabrics, destroying them. Because of it can begin , pseudo-cysts – the cavities filled with liquid contents and nekrotizirovanny fabrics are formed. At hit in the area of pathological process of an infection develops or phlegmon of a pancreas – total purulent fusion, or abscess is formed. It should be noted that phlegmon is heavier and predictively an adverse state, on clinic almost not different from single abscess. Besides, at phlegmon in fabrics multiple abscesses can be formed. Therefore at inspection of the patient with clinic of abscess it is necessary to keep vigilance and to exclude a possibility of existence of phlegmon at it.
Formation of abscess is promoted heavy pancreatitis with more than three risk factors, by postoperative pancreatitis, an early laparotomy, the early beginning of an enteroalimentation, irrational antibiotic treatment.
Pancreas abscess symptoms
Abscess in fabrics is formed is long – usually not less than 10-15 days. Thus, within two-four weeks from the beginning of pancreatitis temperature to febrilny figures increases, there are a fever, tachycardia, pains in the top half of a stomach amplify. Pains have the surrounding character, rather strong. The patient pays attention to weakness, fatigue, lack of appetite, the increased sweating. Nausea, vomiting after which in a mouth bitterness is long felt disturbs. It is available all symptoms of intoxication. At a palpation of a stomach existence of opukholevidny education, tension of muscles of a forward belly wall attracts attention.
Pancreatic abscess often is complicated by further spread of an infection, formation of multiple abscesses in gland and surrounding bodies. Pus can flow zabryushinno, break in hollow bodies (intestines, a stomach), poddiafragmalno and in okolokishechny cellulose, pleural and pericardiac cavities in this connection can be created intestines abscess, poddiafragmalny abscess, purulent pleurisy and perikardit. Also the abscess occasionally can break outside through skin with formation of fistula. Therefore at confirmation of the diagnosis it is necessary to carry out urgentny drainage of an abscess.
At destruction severe bleeding, sometimes with a lethal outcome can arise enzymes of a wall of a vessel.
Diagnosis of abscess of a pancreas
The diagnosis is made after careful inspection of the patient. In the general blood test the shift of a formula of leukocytes to the left, increase in SOE, anemia is noted high . In biochemical blood test increase in level of pancreatic enzymes, a hyperglycemia attracts attention. Urine amylase level is increased though when forming abscess its quantity can gradually decrease.
The radiological research of pancreatic abscess has some features. As gland is located behind a stomach, the shadow of a cavity of an abscess can be imposed on a gas bubble of a stomach. Therefore the exposition has to be longer, and at suspicion of abscess enter contrast substance into a cavity of a stomach and do a vertical picture in a side projection – at the same time the roundish shadow with border of liquid (abscess) will be behind a stomach. At hit of contrast in a cavity of abscess it is possible to speak about existence of fistula.
Also in pictures it is possible to see signs of a sdavleniye of intestines, shift of bodies. The left diafragmalny dome high, its mobility is limited, there can be an exudate in a pleural cavity.
Ultrasonography of a pancreas, KT of abdominal organs will allow to decide on localization and the sizes of the center, quantity of abscesses. If necessary perhaps simultaneous carrying out a chreskozhny puncture with aspiration, a research and crops of contents. The differential diagnosis is carried out with a pancreas pseudo-cyst, pankreonekrozy.
Treatment of abscess of a pancreas
Not the therapist and the gastroenterologist, but the surgeon and the endoscopist are engaged in treatment of suppuration of a pancreas any more. Abscess is the absolute indication to its sanitation and drainage. Practice shows that chreskozhny drainage of abscesses leads to treatment only in 40% of cases, besides at such tactics it is possible to pass phlegmon, multiple abscesses, spread of an infection on people around fabrics. For this reason endoscopic or classical laparotomny excision and drainage of abscess will be the best exit. During operation attentive survey of surrounding bodies, zabryushinny cellulose regarding secondary abscesses is made.
Parallel to the patient antibiotic treatment according to the received crops, the anesthetizing medicines, spazmolitik, inhibitors of enzymes is appointed. Infusional therapy for the purpose of desintoxication is carried out.
Forecast and prevention of abscess of a pancreas
As the reasons of formation of abscesses in a pancreas are up to the end not found out, today there are no measures of prevention of development of this pathology after pancreatitis and a pankreonekroz also. Thus, prevention of an abstsedirovaniye is the prevention of pancreatitis – abscess can be created only on its background.
The forecast when forming abscesses serious: without surgical treatment mortality makes 100%, and after carrying out operation survival of 40-60%. The forecast of a disease depends on timeliness of the address, bystry diagnostics and expeditious treatment. The earlier the diagnosis is made and operation is performed, the it is better the remote results.