Chronic pancreatic abscess with unusual complications

Beller, A. J.; Nach, Robert L.

doi:10.1016/s0002-9610(42)90614-7

The American Journal of Surgery

1942

DOI: 10.1016/s0002-9610(42)90614-7

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Chronic pancreatic abscess with unusual complications

A. J. Beller

Robert L. Nach

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1943

1964

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Cited by 4 publications

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“…Destruction of a major portion of the gland may lead to the development of diabetes mellitus, as in the case of Beller and Nach. 8 We believe that the sequence of events in the present case consisted of an attack of acute hemorrhagic pancreatitis followed by bacterial invasion, involvement of the pancreatic veins, and perhaps the splenic vein, by the 857 infection, and seeding of bacteria or septic emboli into the liver through the portal vein. The spread of infection from pancreas to liver by the lymphatics is also a possibility (Fig.…”

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confidence: 68%

Suppurative Pancreatitis With Associated Liver Abscess

1945

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IN ACCORD with our own experience,1 recent trends in the literature have emphasized the decreased mortality of acute pancreatitis when treated by the conservative nonoperative method, reserving operation for the complications of this disease, namely, pseudocyst and abscess. Within the past three years I9 cases of acute pancreatitis have been encountered in the Jefferson Medical College Hospital, I2 of the edematous type and seven of the hemorrhagic type. In the hemorrhagic group, pseudocyst formation occurred in two cases, and pancreatic abscess, also, in two cases. It is the purpose of this communication to present in detail one case from this series, unusual because of suppuration followed by hepatic abscess, to discuss its pathogenesis and evaluate the factors contributing to recovery.Case Report.-A. T., female, age 55, was admitted to the Surgical "A" Ward Service of the Jefferson Medicil College Hospital, September 30, I944, with the chief complaint of epigastric and right upper abdominal pain.The patient had been well until three days prior to admission, at which time she first experienced moderately severe epigastric and right upper abdominal pain. The pain was constant, did not radiate, and was accompanied by nausea and frequent episodes of vomiting of greenish-yellow material. She also had diarrhea, with passage of four loose stools daily for two days. From the onset of the attack she remained confined to bed and had fever.The past medical history revealed that the patient previously had always enjoyed excellent health. She had been free of indigestion and was able to tolerate all types of food.Physical Examination.

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confidence: 68%

Suppurative Pancreatitis With Associated Liver Abscess

1945

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Pancreatic Abscess

Altemeier¹

1963

Arch Surg

104

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Abscess of the pancreas

Ingall

1964

Journal of British Surgery

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PANCREATIC abscess is a rare condition. Most reports in the literature are of individual patients, although ~~l~~~ (1957) reported 6 in the cincinnati area between 1948 and 1957.INVESTIGATIONS.-A leucocytosis of-14,400 with 82 per cent polymorphs was present. The serum amylase was 1530 A units; suhsequcnt readings throughout the illness are shown in k ' i~. I. Electrolytes and blood-urea were normal. The blood-sugar was 149mg. per cent. A catheter specimen of urine was sent for culture and sensitivities. CASE REPORTMrs. M. w., a 59-Year-old woman, weighing 12; sf.A diagnosis of acute pancreatitis with associated galland 5 ft. high, was admitted in September, 1962, with bladder ciysfunction was made. severe upper abdominal pain. She complained of mild Liver function tests revealed a reversed albuminglobulin ratio of 0.86 : I . Fluctuations of these values t;i(;. i.-Thc arrow indicates the time at which the pancreatic abscess was drained into the stomach. The rise in serum amylase immediately preceding this coincided with a deterioration in the ,ltnical condi:ton epigastric disornfort and occasional vomiting of greenish fluid during the previous month, much worse during [he wcck before admis.;ion. I h r i n g [hex last 7 days she had been treated for acute cholecystitis by her own doctor, who commentd on the large amount of green vomitus.One ycar previously she had complained of pain to the right of the epigastrium associated with flatulent dyspepsia. A cholecystogram had failed to demonstrate the gallbladder, but following this her symptoms disappeared. In view of her gross obcsity and general well-being, operation was deferred indefinitely. She remained well, having a low-fat diet, until thc present episode began.EXAMINATION.-shC was a grossly obcse paricnr, in very obvious pain; pulse-rate 140 per minute, with regular rhythm and good volume; temperature 98.2" F. ; ELI' . 140'100; urine and fasces normal in colour. She was not clinically jaundiced.The abdomen was fat with a large dependent apron hanging down over the mons and groin creases. To support this she had becn wearing a specially designed belt. No abdominal masses were fclt, but there was guarding and tenderness in the epigastric region. Bowel-sounds were present and normal in character, albeit faint and difficult to hear. Rectal examination was uninformative. FIG. 2.-This shows the gradual seturn of the plasma alhuminglobulin ratio to normal following thc 5ul)sidence of the severe toxaemia.throughout her illness are graphed in Fig. 2. 'lhe specimen of urine taken on admission was reported to contain Bacillus coli, with a moderate number of hyaline casts, red blood-cells, and pus cells. Symptomatically her cystitis had responded to treatment with terramycin, prescribed on admission. A further specimen and culture confirmed this.CLINICAL Couwh.--On admission her temperature was normal. Pyrexia developed the next day and initially responded to terramycin, but subsequently inrceased with marked diurnal fluctuation.Palpation of the abdomen attempting to ...

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Chronic pancreatic abscess with unusual complications

Cited by 4 publications

References 4 publications

Suppurative Pancreatitis With Associated Liver Abscess

Suppurative Pancreatitis With Associated Liver Abscess

Pancreatic Abscess

Abscess of the pancreas

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