Pancreatic Abscess: An Infection Occurring with Minimal Tissue Present

Pancreatic abscess typically occurs 4 weeks after acute pancreatitis begins and is defined as an infection of the pancreatic pseudocyst. There are other causes which include but are not limited to iatrogenic intra-abdominal procedures, chronic pancreatitis, and sending from distant sites. These abscesses are typically collections of pus that are within the region of the pancreas. There is also pancreatic necrosis that is seen among these abscesses. Here is a report on a case of a pancreatic abscess of unusual occurrence in a patient that had a near-total distal pancreatectomy. This is uncommon as the patient has very minimal pancreatic tissue remaining, yet still has developed this intra-abdominal abscess. These abscesses must be recognized quickly and removed to prevent further complications from occurring.

A long journey： report of a case with pancreatic abscess extending to the groin

Acute pancreatitis is an inflammatory process with .variable involvement of regional tissue, remote organ systems, or both. Various complications of pancreatitis are common, including intra- or extrapancreatic fluid collections and development of a pancreatic pseudocyst or abscess, or even pancreatic tissue necrosis. Infected necrosis involves diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue without significant pus collection. In contrast, a pancreatic abscess is a circumscribed collection of pus, usually in proximity to the pancreas, that is positive for bacteria, bounded by adjacent tissue and organs and has minimal amounts of associated necrosis.

The microbiology of infected pancreatic necrosis

Background: Acute pancreatitis(AP) continues to cause significant morbidity and mortality, especially when it leads to infected pancreatic necrosis(IPN). Modern treatment of IPN frequently involves prolonged courses of antibiotics in combination with minimally invasive therapies. This study aimed to update the existing evidence base by identifying the pathogens causing IPN and therefore aid future selection of empirical antibiotics. Methods: Clinical data, including microbiology results, of consecutive patients with IPN undergoing minimally invasive necrosectomy at our institution between January 2009 and July 2016 were retrospectively reviewed. Results: The results of 40 patients(22 males and 18 females, median age 60 years) with IPN were reviewed. The etiology of AP was gallstones, alcohol, dyslipidemia and unknown in 31, 2, 2 and 5 patients, respectively. The most frequently identified microbes in microbiology cultures were Enterococcus faecalis and faecium(22.5% and 20.0%) and Escherichia coli(20.0%). In 19 cases the cultures grew multiple organisms. The antibiotics with the least resistance amongst the microbiota were teicoplanin(5.0%), linezolid(5.6%), ertapenem(6.5%), and meropenem(7.4%). Conclusion: The carbapenem antibiotics, ertapenem and meropenem provide good antimicrobial cover against the common, mainly enteral, microorganisms causing IPN. Culture and sensitivity results of acquired samples should be regularly reviewed to adjust prescribing and monitor for emergence of resistance.

The Open Packing of the Lesser Sac Technique in Infected Severe Acute Pancreatitis

Aim: The goal of this study is to evaluate the open packing of the lesser sac (OPLS) in treatment of infected severe acute pancreatitis Methodology: The study was based on 98 cases in which this technique was applied during the period between 19942007, in two departments of surgery (Clinical Hospital CF 2 and Clinical Hospital ?Sf. Maria” Bucharest). The technique was applied based on the therapeutically protocol previously established beginning with 2000. The OPLS technique was analyzed relatively to: timing of surgery, the localization of the infected necrosis or abscesses, growing germs on the cultures, antibiotics received, executed primarily or at reintervention, the number of debridement, hospitalization, morbidity and mortality. The information was statistically processed using SPSS test version 17 for Windows. Results: The OPLS technique improved the control of the local sepsis, in the retrospective/prospective study in 83.7%. Mortality was 16.3% (16/98), with a global mortality of 26.3% (75/285) and a postoperative mortality of 29.5% (66/224). Conclusions: Considering the fact that the intensive care techniques are approximately the same in the last 15 years, we thought that this improvement in the survival rate may be due to the application of OPLS in cases with indication and optimal timing for surgery.