Purulent pancreatitis

Purulent pancreatitis is a serious disease accompanied by acute inflammation of the pancreas. Most often, the inflammatory process leads to the formation of purulent abscesses on the affected organ.

Acute pancreatitis currently ranks third in the ranking of acute abdominal diseases requiring immediate treatment in a surgical hospital. Acute appendicitis ranks first in this ranking, and acute cholecystitis ranks second. According to world statistics, acute pancreatitis is detected annually 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 severe condition of the patient with a high risk of death. The disease mainly occurs as an immediate reaction to various etiological factors, in particular, food intoxication, neurovascular disorders, etc.

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

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Causes of purulent pancreatitis

Purulent pancreatitis can develop for a number of reasons. These can be either congenital anomalies of the pancreas or various inflammatory diseases of the digestive organs.

The most common causes of purulent pancreatitis are:

• alcohol abuse (chronic and acute alcoholism);
• various intoxications;
• viral infection (mumps, hepatitis B and C);
• bacterial infection;
• cholelithiasis;
• diseases of the stomach and duodenum (ulcer, gastroduodenitis);
• appendicitis;
• taking medications that have a pathological effect on the pancreas: antibiotics, immunosuppressants, estrogens, azathioprine, as well as corticosteroids and thiazide diuretics;
• surgical interventions and various injuries of the pancreas;
• genetic predisposition.

Acute inflammation of the pancreas, which results in purulent pancreatitis, according to the main medical theory, develops as a result of damage to the cells of this organ by enzymes that have been activated prematurely. During normal functioning of the pancreas, digestive enzymes are produced in their inactive form. They are activated while in the digestive tract. However, under the influence of various pathological factors, enzymes can be activated directly in the pancreas, which leads to self-digestion of its tissues. The result of this process is tissue edema, acute inflammation, damage to the vessels of the pancreatic parenchyma, the development of abscesses, i.e. purulent pancreatitis.

The pathological process often spreads to the peritoneum and retroperitoneal tissue, intestinal loops, omentums and other nearby tissues. There are pronounced disturbances in vital functions in the form of secondary inflammations in other organs and the emergence of dystrophic disorders.

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Symptoms of purulent pancreatitis

Purulent pancreatitis makes itself known by a decrease in appetite, which is accompanied by frequent belching, dry mouth, hiccups, bloating and nausea. Since the development of purulent pancreatitis disrupts the functioning of the digestive organs, the patient loses a lot of weight. Vomiting is a constant process that accompanies this disease.

Other symptoms of purulent pancreatitis:

• paroxysmal abdominal pain - most often in the epigastric region (cutting, dull, cramping, encircling, increasing);
• increased heart rate;
• chills;
• increased temperature due to intoxication;
• the appearance of shortness of breath;
• lowering blood pressure;
• bloating;
• diarrhea or constipation;
• a sharp deterioration in the patient's health;
• pronounced leukocytosis.

The progressive course of the disease provokes a deterioration in the person's condition - debilitating pain wears him down. Any movement, cough, deep breath cause an attack of unbearable pain, sometimes leading to a state of shock.

The skin may become covered with cyanotic spots (Cullen's symptom), most often in the umbilical region and on the lateral parts of the abdomen. Due to the breakthrough of pus into the abdominal cavity, peritonitis may develop, which, in turn, increases the risk of death.

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 an 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, typhoid or mumps. The disease occurs against the background of severe, debilitating pain in the upper abdomen, often leading to shock and collapse. In pain shock, a person's face becomes ashen-gray, and the pulse is almost impossible to feel. 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 diseases, poor nutrition, and pancreatic injury.

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Diagnosis of purulent pancreatitis

Purulent pancreatitis is diagnosed by studying a blood test (general, detailed, biochemical) and urine in a laboratory, performing an abdominal X-ray, and, if necessary, other medical examinations. A high level of leukocytes (leukocytosis), the release of pancreatic enzymes, in particular, an increase in the amylase index, an acceleration of the ESR, an increase or decrease in the blood sugar level - this is a typical picture of the development of purulent pancreatitis. Abdominal X-ray may show signs of intestinal paresis (obstruction), flatulence of the colon, as well as a high position of the diaphragm.

Diagnosis of purulent pancreatitis is also carried out using ultrasound examination of the pancreas, which shows an increase in the size of the organ due to severe inflammation. In addition, cysts and abscesses are observed. Sometimes, for a more accurate diagnosis, it is necessary to examine the diseased organ through a special instrument - a laparoscope, i.e. laparoscopy of the pancreas is performed.

In general, the diagnosis of "purulent pancreatitis" is made on the basis of clinical data. When purulent pancreatitis develops, the prevalence of abscess "melting" of the pancreas is noted. Detection of the disease requires immediate hospitalization of the sick person. Patients with such a diagnosis are placed in the intensive care unit.

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Treatment of purulent pancreatitis

Purulent pancreatitis is a disease that requires emergency care and constant medical supervision of the patient exclusively in a hospital setting.

Treatment of purulent pancreatitis during catarrhal (edematous) phases of the disease involves strict bed rest and gastric lavage with cold water. The patient is prescribed alkaline drinks, an ice pack on the stomach and fasting. Painkillers, antispasmodics (no-shpa, baralgin, papaverine, etc.), and diuretics to relieve swelling are administered to the body by IVs and injections. Heparin, novocaine and novocaine blockades, rheopolyglucin are prescribed; almagel, ranisan, trasylol, cimetidine, etc. are most often used to reduce pancreatic secretion.

A severe form of purulent pancreatitis (transition of the inflammatory process to a destructive form) with hemorrhages and formation of multiple abscesses in the tissues of the pancreas requires urgent surgical intervention. The main goal of the surgical operation is to cleanse the body of toxins, prevent dehydration and stop the destruction of the gland by limiting the inflammatory process. A contraindication to the operation may be an extremely serious condition of the patient, who cannot be brought out of shock.

The optimal solution for surgical treatment is laparotomy – an operation performed by cutting the abdominal wall, which allows access to abscesses and their careful removal. During the operation, constant scanning is performed, as well as monitoring of the patient's condition using visualization methods – CT, fluoroscopy, ultrasound. If the patient simultaneously has purulent inflammation of the gallbladder, he may undergo cholecystectomy (removal of the gallbladder) or cholecystostomy (external drainage of the gallbladder).

Prevention of purulent pancreatitis

Purulent pancreatitis can be prevented by following preventive measures. First of all, a person should constantly monitor their health, including timely detection and effective treatment of various gastrointestinal diseases, cholecystitis, and cholelithiasis. When diagnosing any disease of the internal organs, including the pancreas, it is necessary to undergo a full course of treatment, following all the instructions of the attending physician. At the first symptoms of the development of a gastrointestinal disease (nausea, vomiting, diarrhea, heartburn, pain in the hypochondrium, stomach and other places), you should consult a doctor.

Prevention of purulent pancreatitis also involves combating overeating, obesity, and alcohol abuse. It is important to stick to a diet if there are pathological changes in the functioning of the digestive organs, pancreas, and gall bladder. For this purpose, a diet rich in carbohydrates is best suited, i.e. containing rice, low-fat milk, white crackers, cottage cheese, and fruit juices.

It is very important to follow the rules of rational nutrition, to give up bad habits, including smoking, alcohol, drug use. Sanatorium and resort treatment helps to avoid complications and exacerbations of gastrointestinal diseases.

Prognosis of purulent pancreatitis

It is very important to detect purulent pancreatitis in time to minimize the risk of death. Since severe forms of the disease can cost a person their life.

The prognosis of purulent pancreatitis is always very serious. Complications arising from acute pancreatitis are mainly associated with the release of a huge amount of pancreatic enzymes and toxic products of its decay (pancreatic necrosis) into the blood. Intoxication of the body and severe pain during an attack cause shock in the patient - a life-threatening condition. A formidable complication of this disease is also enzymatic diffuse peritonitis, which has an aseptic nature and develops against the background of an excess of pancreatic enzymes, which have an aggressive effect on the peritoneum.

Severe intoxication of the body, which is observed during acute pancreatitis, is dangerous because it can lead to acute renal and hepatic failure, development of jaundice, ulceration of the gastric mucosa, pulmonary edema as a result of toxic pneumonia, as well as psychosis of toxic genesis. It should be emphasized that the course and further prognosis of purulent pancreatitis are significantly affected by alcohol intake. If the patient, despite the diagnosis of a severe form of the disease, continues to drink alcohol, the risks of a fatal outcome are doubled.

It is important to remember that the main cause of death in patients with purulent pancreatitis is severe intoxication of the body in combination with purulent-septic complications. In particularly advanced cases, sepsis develops. The prognosis for purulent pancreatitis is significantly worsened by late complications of this disease. Most often, these are abdominal abscess, sepsis, retroperitoneal phlegmon, and pylephlebitis.

Fatal outcome in purulent pancreatitis

Purulent pancreatitis is primarily dangerous because it can lead to death. Severe intoxication of the patient's body causes damage not only to the pancreas itself, but also to other vital organs - the brain, kidneys, heart, lungs. Tissue decay products and enzymes are absorbed into the blood, causing rapid poisoning of the entire body. This is the reason for the high risk of death.

The fatal outcome of purulent pancreatitis is observed in 10-15% of the total number of cases of the disease. If at first the damage to the internal organs due to acute pancreatitis is focal, then as the disease develops, the inflammation rapidly "attacks" almost the entire body, leading to its severe intoxication. The patient's health worsens with each passing minute, causing unbearable suffering. In most cases, the patient's death occurs due to untimely diagnosis. As a result, pathogenetic therapy does not give the desired results, since it is applied too late.

Purulent pancreatitis is a dangerous disease that requires immediate medical intervention. Therefore, it is so important to detect the disease in a timely manner in order to save a person's life.