Pancreatitis is a disease characterized by inflammation of the pancreas. The pancreas is a long gland behind the stomach that produces hormones and digestive enzymes. Pancreatitis occurs when these digestive enzymes start to leak and damage the pancreas, leading to inflammation 1.
There are two forms of pancreatitis; chronic, and acute. Chronic pancreatitis develops slowly over many years, whereas acute pancreatitis appears suddenly and may for last several days 2.
Necrotizing pancreatitis is a severe complication of acute pancreatitis in which the digestive enzymes start to kill pancreatic tissue. The dead (necrotic) tissue can then become infected, which may lead to life-threatening complications. Treatment for necrotizing pancreatitis usually involves medication and surgical removal of the dead, infected tissue 3.
Symptoms of Necrotizing Pancreatitis
The main symptom of necrotising pancreatitis is abdominal pain 4. This may be felt at the front of the abdomen, near the stomach or around the back.
Other symptoms of necrotizing pancreatitis may include:
- Swollen abdomen
- Low blood pressure
- Rapid heart rate
Causes of Necrotizing Pancreatitis
Necrotizing pancreatitis usually develops as a complication of acute pancreatitis. People with chronic pancreatitis can also get necrotizing pancreatitis, but this is far less common. If pancreatitis is left untreated, or if treatment is ineffective, the leaked digestive enzymes can cause irreversible damage to the pancreatic tissue.
Pancreatitis has many possible causes, though alcohol consumption and gallstones are the most common.
Other genetic, environmental and lifestyle factors that can cause necrotizing pancreatitis include 5:
- Excessive alcohol consumption
- Having gallstones (small stones in the gallbladder)
- Tumors in the pancreas
- High levels of calcium in the body
- Damage to the pancreas due to medication or injury
- High cholesterol levels
- Autoimmune diseases
- Hereditary conditions that affect the pancreas (e.g. cystic fibrosis)
Risk Factors for Pancreatitis
Necrotizing pancreatitis is a severe complication of acute pancreatitis. You are more likely to develop pancreatitis if you 6:
Drink excessively - Studies have shown that chronic drinking causes up to 25% of acute pancreatitis cases worldwide, and up to 70% of chronic pancreatitis cases 7.
Have gallstones - Gallstones (small stones that form in the gallbladder) are the most common cause of pancreatitis 8. Gallstones can block the bile duct, preventing digestive enzymes from moving into the small intestine and forcing them back into the pancreas, where they cause inflammation. People with a genetic predisposition to gallstone disease are more likely to develop pancreatitis 9.
Smoke cigarettes - Research has found that tobacco smoking increases the risk of both acute and chronic pancreatitis 10.
Are obese - Obesity not only increases the risk of acute pancreatitis, but it also makes the symptoms and severity of the condition worse 11.
Have a family history of pancreatitis - In some cases, pancreatitis can be caused by a genetic mutation and can be hereditary 12. You are more likely to develop hereditary pancreatitis if other members of your family have the condition.
Complications of Necrotizing Pancreatitis
Necrotizing pancreatitis is a potentially fatal disease and leads to serious complications in up to 30% of patients, which include 13:
- Insufficient pancreatic enzymes (which can leave the patient unable to digest food)
- Organ failure
- Fistulae (abnormal holes in the walls of bodily structures)
- Internal bleeding
Besides necrotizing pancreatitis, acute pancreatitis can also lead to a variety of other life-threatening complications, which include 14:
- Obstruction of the bile ducts or pancreatic ducts
- Leakage from the pancreatic ducts
- Pseudocysts (fluid filled cavities that may rupture, haemorrhage or lead to infection)
- Damage to the pancreas
- Pleural effusion (fluid in the lungs – AKA ‘water on the lungs’)
- Splenic vein thrombosis (a blood clot blocking the splenic vein)
Diagnosis of necrotizing pancreatitis
The initial step for diagnosing necrotizing pancreatitis is a consultation with a doctor, during which they will ask questions about your health history and symptoms. If necrotizing pancreatitis is suspected, your doctor may perform blood and imaging tests to confirm the diagnosis.
Blood tests for necrotizing pancreatitis are used to look for signs that the pancreas is damaged, which include 15:
- High levels of pancreatic enzymes in the blood
- High blood cholesterol levels
- High levels of other substances, such as glucose, sodium and potassium
Imaging tests for necrotizing pancreatitis may include an abdominal ultrasound, a CT scan or an MRI scan. These tests are used to visually examine the pancreas for inflammation, and to rule out other possible causes for your symptoms (such as pancreatic cancer, ulcers or inflammation of the gallbladder).
Imaging tests can also be used to determine the extent of damage to the pancreas and identify other potential complications 16.
If imaging tests reveal that parts of your pancreatic tissue have died, the doctor may want to perform a biopsy test to check for signs of infection 17. During a biopsy test, a very thin needle is inserted into the pancreas and used to take a small piece of tissue to be analysed.
Treatments for Necrotizing Pancreatitis
Necrotizing pancreatitis is a severe complication of acute pancreatitis which, without treatment, can lead to fatal complications. Treatment for necrotizing pancreatitis is two-fold and addresses both the pancreatitis and the dead pancreatic tissue.
Treatment for Pancreatitis
Pancreatitis is treated with rest, plenty of IV fluids and, in certain cases with pain medication and medicines to prevent vomiting 18. You may also need to be fed nutrients in liquid form, which are typically administered via a tube inserted through the nose and into the stomach.
If any of your pancreatic tissue dies and becomes infected, you will need antibiotics. In most cases of infection, the infected tissue must also be removed.
Removal of Necrotic Tissue
If parts of your pancreatic tissue have died and become infected, they will often need to be surgically removed 19. Usually, this is done using a catheter or via an endoscopic procedure, both of which are minimally invasive surgeries. In more severe cases, open surgery may be required to remove the necrotic tissue.
Surgery may not be necessary if the dead pancreatic tissue has not become infected. Your doctor will be able to inform you of the risks and benefits of having the tissue removed vs. leaving it where it is.
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Quick Facts on Necrotizing Pancreatitis
Global incidence rate of acute pancreatitis
The incidence rates of acute pancreatitis vary significantly worldwide, affecting between 5 and 80 people out of every 100,000 20.
The highest rates have been recorded in the United States and Finland, where the disease affects 73.4 people per 100,000.
Necrotizing Pancreatitis and Age
Necrotizing pancreatitis can affect anyone with pancreatitis, but it is more common among older patients (those aged 65 and above) 21.
Necrotizing Pancreatitis and Gender
Acute pancreatitis generally affects more men than women, in whom the disease is more commonly related to alcohol consumption 22. However, studies have found no evidence that the gender of the patient affects the severity or outcome of pancreatitis 23.
Necrotizing Pancreatitis Cases With a Fatal Outcome
Necrotizing pancreatitis is a severe complication of acute pancreatitis and, if left untreated, can lead to life-threatening infections. Mortality rates vary, but an estimated 17% of necrotizing pancreatitis cases are fatal 24.
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