The commonest complication of acute pancreatitis is: (AIIMS Nov 2009)
|A||Pseudocyst of Pancreas|
|B||True cysts of pancreas|
|D||Pus in Morrison's pouch|
a. Acute Fluid Collections.
i. Occur during the early stages of severe pancreatitis in 30% to 50% of patients
ii. Lack a wall of granulation or fibrous tissue, and more than half regress spontaneously.
iii. Most are peripancreatic, but some are intrapancreatic.
iv. Those that do not regress may evolve into pseudocysts or involve areas of necrosis.
b. Pancreatic and Peripancreatic Necrosis.
i. These are areas of nonviable pancreatic or peripancreatic tissue that may be either sterile or infected.
ii. They typically include areas of fat necrosis, and the necrotic tissue has a puttylike or pastelike consistency.
iii. Some necrotic regions may evolve into pseudocysts, whereas others may be replaced by fibrous tissue.
c. Pancreatic Pseudocyst.
i. These are collections of pancreatic juice, usually rich in digestive enzymes,that are enclosed by a nonepithelialized wall composed of fibrous and granulation tissue.
ii. Pseudocysts can be intrapancreatic but are more commonly extrapancreatic and occupy the lesser peritoneal sac.
iii. Pseudocysts are usually round or oval in shape and are not present before 4 to 6 weeks after the onset of an attack.
iv. The fluid collection lacks a defined wall and is usually either an acute fluid collection or a localized area of necrosis (see earlier).
v. When pus is present, the infected pseudocyst is referred to as a pancreatic abscess.
vi. Leakage or rupture of a pseudocyst into the peritoneal cavity results in pancreatic ascites.
d. Pancreatic Abscess and Infected Pancreatic Necrosis.
i. These are circumscribed intra-abdominal collections of pus, usually in proximity to the pancreas, which contain little or no necrotic tissue but arise as a consequence of pancreatitis.
ii. An infected pseudocyst is considered a pancreatic abscess.
iii. Pancreatic abscess and infected pancreatic necrosis represent the extremes of a spectrum that includes lesions with varying amounts of necrosis.
iv. Thus, in a pancreatic abscess, there is little necrosis, and the material has a liquid consistency, whereas in infected pancreatic necrosis, necrosis predominates, and the material is pastelike or puttylike