SEQULAE OF ACUTE BILIARY PANCREATITIS

Once acute biliary pancreatitis is made, it has to be treated with analgesics, intravenous fluids, antibiotics if required and not to give anything orally till start showing the signs of recovery. After stabilisation, the bile duct stone has to be addressed with ERCP and stone extraction with biliary stenting if required. After performing bile duct stones extraction with biliary stenting then definitive procedure like laparoscopic cholecystectomy has to be done. Meantime the patient can develop complications related to acute biliary pancreatitis.

The common complications of acute biliary pancreatitis are,

1. Acute pancreatic necrosis
2. Acute peripancreatic fluid collection
3. Infection of acute pancreatic necrosis
4. Pancreatic abscess
5. Development of pseudocyst of pancreas
6. Organ dysfunction

  1.  ACUTE PANCREATIC NECROSIS

    Most of the patients with acute biliary pancreatitis recover once the bile duct stones are managed. But, a few percentages of patients will go for complications like pancreatic necrosis. Here, there will be loss of blood supply to the damaged pancreas and the pancreatic tissue become non-viable. There will be change in colour and may get infected. If getting infected then there will be features of infection like fever, more abdominal pain and systemic features of sepsis like kidney failure, lung failure etc. In case of infection, the primary treatment is systemic antibiotics. If not subsided with antibiotics may require necrosectomy.

  2. ACUTE PERIPANCREATIC FLUID COLLECTION

          This occurs following acute pancreatitis due to any cause. There will be fluid collection around the pancreas. This can be due to fluid accumulation due to pancreatitis or leaking of fluid from the pancreatic ducts due to destruction of pancreatic parenchyma. Most of the time this fluid will disappear spontaneously. But sometime the collection will not disappear due to persistent leak from the destructed pancreatic parenchyma. If the fluid collection persists more than six weeks, it is called as “Pseudocyst of Pancreas” and may require surgical intervention.   

  3. INFECTED PANCREATIC NECROSIS

         Here there will be pancreatic necrosis along with infection and the source of infection is from blood or from the large intestine. First line of management is antibiotics and may require surgical management. The indications for surgery are,

• Evidence of infected necrosis
• Evidence of severe systemic infection
• Pancreatic abscess formation
• Infected necrosis with organ failure

      The recommended procedure is necrosectomy which can be done through laparoscopic technique or open surgical method depending on the general condition of the patient and location of the infected pancreatic necrosis.

  4. PANCREATIC ABSCESS

        In this condition there will be fluid collection within the pancreas with infection. There will be persistent pain with fever and sometime epigastric tenderness and mass will be there. Computerised tomography with intravenous contrast is the investigation to confirm the pancreatic abscess. The presence of persistent abdominal pain with features of systemic infection is an indication for drainage procedures for pancreatic abscess.

       The pus can be drained by radiological technique, laparoscopic technique or by open technique. Radiological technique can drain the pus only. But the laparoscopic and open technique will be useful to drain the pus along with necrosectomy if required.

• PSEUDOCYST OF PANCREAS

       It is a localized fluid collection within the pancreas or around the pancreas. The time duration for the development of acute pancreatitis to pseudocyst formation is around six weeks duration. The pseudocyst can present with abdominal pain with or without epigastric palpable mass. The presence of symptoms, palpable mass with bigger cyst (More than 6cm) necessitate surgical intervention. The commonly done surgical procedure is laparoscopic cystogastrostomy, open cystogastrostomy or cystojejunostomy. The nature of the procedure will be decided depending on the location of cyst and its relation with stomach.

• ORGAN DYSFUNCTION

    The acute pancreatitis can lead to pancreatic necrosis or pancreatic abscess formation in turn can leads to severe systemic infection and septicemia. The septicemia may end up with single or multiple organ dysfunction. The commonly affected organs are kidney, lungs and liver. The treatment is directed towards haemodynamic stabilization with intravenous fluids with pressure support, systemic infection control with antibiotics and source control with pancreatic necrosectomy or pancreatic abscess drainage.