A health condition that causes necrosis (tissue death) due to severe inflammation is called necrotizing pancreatitis. While some people with this condition may develop short-term complications, others may develop serious and chronic (long-term) complications. Treatment usually involves surgery to remove damaged or removed tissue.
Sometimes, this condition is a complication of acute pancreatitis in which a part of the pancreas tissue dies. Usually, it occurs when a person develops a severe form of pancreatitis. Generally, pancreatitis is a health condition that causes inflammation and swelling in the pancreas in response to toxins or injuries. When severe inflammation occurs, it restricts blood flow to the pancreas tissues (ischemia), which causes tissue death (also known as necrosis).
In most cases, people with necrotizing pancreatitis get treatment in the hospital and may stay there for some time to watch out for complications. One of the most serious complications happens when bacteria go to the dead tissue, where they begin to multiply and grow quickly. This is considered a medical emergency, and without immediate treatment, it may lead to organ failure and even death.
In general, about 20% of people with acute pancreatitis also develop necrotizing pancreatitis in the U.S. However, the acute form of pancreatitis affects about 275,000 people each year.
Symptoms
People with a mild form of necrotizing pancreatitis often experience the following symptoms. For example:
- Severe upper abdominal pain (sometimes, it may spread to the back)
- Nausea
- Vomiting
- Abdominal distension
- Bloating
When the condition advances, it may cause additional symptoms. These include:
- Fever
- Chills
- Fast heart rate (also known as tachycardia)
- Severe thirst or dehydration
Immediately contact your healthcare professional if any of the symptoms listed above occur. Otherwise, it may lead to life-threatening complications.
Causes
In most cases, the causes of necrotizing pancreatitis happen in stages. It often starts with acute pancreatitis and then becomes severe. Afterward, ischemia sets in, and finally, necrosis occurs. The previous events often have their own cause.
First Stage
One of the most common causes of severe acute pancreatitis is gallstone disease. It occurs when a gallstone obstructs (blocks) the pancreatic duct. Sometimes, it is called gallstone pancreatitis. The second leading cause is misuse of alcoholic drinks. Inflammation usually occurs as a response of the immune system that tries to repair the damage, but in some cases, the inflammatory responses can be as severe as they also cause damage.
Healthcare professionals do not always understand why some people have a stronger inflammatory response while others do not. Moreover, in severe cases, inflammation can put too much pressure on the pancreatic enzymes within the pancreatic tissues. As a result, these digestive enzymes activate and begin to digest the pancreas. Normally, these enzymes are inactive until they reach the digestive system.
Second Stage
The damage caused by the immune system and digestive enzymes continues to escalate pancreatitis. Thus, it leads to swelling in the pancreas that compresses blood vessels, causing a reduced blood flow to the pancreas tissues.
Sometimes, people develop systemic inflammatory response syndrome (SIRS), which is an additional contributing factor. SIRS causes a whole-body inflammatory response that may cause a sudden drop in blood pressure and blood flow. Finally, reduced or a lack of blood flow (ischemia) causes tissue death (necrosis). Some experts think that digestion by pancreatic enzymes could also play a role.
What Are The Possible Complications of Necrotizing Pancreatitis?
People with necrotizing pancreatitis may develop short- or long-term complications. Check some of them below:
Short-term Complications
- Infection – This complication occurs in about 20% of cases. It happens when the bacteria go to the dead tissue and begin to grow and multiply fast. Moreover, when these bacteria enter the bloodstream, they may lead to sepsis. This is a life-threatening infection that may lead to multiple organ failure. In addition, sepsis is one of the leading causes of death in people with this type of pancreatitis.
- Necrotic fluid collections – In more severe cases, activated pancreatic enzymes may begin to leak from the pancreas and cause irritation to the surrounding tissues. In such cases, there is a capsule of thin tissue that develops around the pancreatic fluid. It contains necrotic tissue, and if bacteria are trapped in this fluid, it may lead to an infection. Rarely, this capsule may become large enough to put pressure on nearby organs.
- Hemorrhage – In general, a hemorrhagic form of pancreatitis occurs quite rarely but is life-threatening. However, in people with necrotizing pancreatitis, the risk of hemorrhage significantly increases. Commonly, it happens because of the inflammation or pancreatic enzymes that can erode the artery walls. As a result, it may lead to a pseudoaneurysm that may rupture and bleed.
- Abdominal compartment syndrome – It is also a serious complication in which bleeding, swelling, and other fluid may build up within the abdominal cavity and cause intense intra-abdominal pressure. This complication may also restrict blood flow to the organs, causing blood clots, ischemia, or hypoxia (reduced oxygen levels in the blood).
Long-term Complications
- Pancreatic insufficiency – When people lose too much of pancreatic tissue, it may lead to reduced functionality of the pancreas. One of the most common problems is exocrine pancreatic insufficiency that may lead to malabsorption and malnutrition. However, endocrine pancreatic insufficiency reduces the production of hormones that regulate sugar levels in the blood. Hence, it may lead to hyperglycemia (increased blood sugar levels) and diabetes.
- Disconnected pancreatic duct syndrome – In some cases, the pancreatic duct is partially disconnected from the pancreas or small intestine. It occurs due to severe swelling, bleeding, or necrosis. When this complication occurs, it may lead to chronic leaking of the pancreatic enzymes.
- Biliary stricture – In severe cases, inflammation can cause scarring in the ducts that connect the pancreas to the digestive system. For example, the pancreatic duct, bile ducts, and duodenum (the upper part of the small intestine). Thus, scarring causes abnormal narrowing of the ducts that slow the passage of bile, causing the bile to flow backward into the biliary system.
- Splanchnic vein thrombosis – Normally, the splanchnic vein goes along the underside of the pancreas, and in people with severe pancreatitis, it can become compressed. As a result, it may lead to blood clots (also known as thrombosis). This vein includes the splenic vein, mesenteric vein, hepatic vein, and portal vein. Moreover, thrombosis may also cause some complications, such as portal hypertension (high blood pressure), gastrointestinal varices or bleeding, ischemic colitis, and mesenteric ischemia.
Diagnosis
In most cases, the diagnosis of necrotizing pancreatitis begins with a physical examination in which doctors will check for abnormalities linked to the disease. However, if you have symptoms of necrotizing pancreatitis, doctors may perform a contrast-enhanced CT (computed tomography) scan or MRI (magnetic resonance imaging) to identify necrosis. These imaging tests may also help find fluid collections.
Treatment
Doctors often prescribe different treatments for people with this condition because they depend on several factors. These include whether you develop an infection, the severity of the condition, age, overall health, and preferences. Check below some treatments often recommended by doctors:
Conservative Management
Doctors may recommend painkillers, IV (intravenous) fluids, or enteral nutrition if you develop a mild form of this condition. However, if you experience a moderate form of necrotizing pancreatitis, doctors may perform a complete blood cell count (CBC) to check for complications. Some people may need other interventions if they develop infections or organ failure.
Drainage and Debridement
The following treatments are recommended when a person has infection symptoms. In most cases, the treatment begins with antibiotics and options to remove necrotic tissue. Check some options below:
- Percutaneous drainage – During this treatment, an interventional radiologist uses an ultrasound or CT scan to find necrotic tissue and install a drainage tube. Furthermore, about 30% of people with necrotizing pancreatitis need this treatment.
- Endoscopic debridement – This treatment is used to access necrotic tissue internally without cutting the skin. Usually, they use an endoscope that is inserted through the GI tract and guided with an ultrasound. Thus, surgeons will pass surgical tools through this endoscope to remove dead tissue.
- Video-assisted retroperitoneal debridement (VARD) – In general, VARD is a minimally invasive treatment used to remove dead tissue. During this procedure, surgeons often use long forceps, irrigation, and suction. Sometimes, they may use a laparoscope (a tube with a video camera attached).
- Open surgery (necrosectomy) – This treatment is often recommended by doctors when previous treatments are not an option. During necrosectomy, surgeons will make an opening in the abdominal cavity to find and remove dead tissue.
Frequently Asked Questions
What are the mortality and survival rates for necrotizing pancreatitis?
In general, the survival rates are different among people because it depends on how much necrosis you have and whether you develop an infection or organ failure. For instance, if the condition affects about 30% of the pancreas, the mortality rate is about 15%, but if it affects 50% of the pancreas, the mortality rate increases to 30%.
What happens after treatment for necrotizing pancreatitis?
Sometimes, long-term complications may develop after treatment for this condition. People who continue to experience symptoms after treatment should see a doctor for additional laboratory and imaging tests. Some people may need additional treatment for the necrotizing pancreatitis complications.
What is the cause of necrotizing pancreatitis?
The most common causes of necrotizing pancreatitis (in the U.S.) are gallstone disease and misuse of alcoholic beverages. If you have additional questions, ask your healthcare provider.
