Complications-acute pancreatitis

• Systemic: ARDS, abdominal compartment syndrome, AKI, GIB (pseudoaneurysm), DIC

• Metabolic: hypocalcemia, hyperglycemia, hypertriglyceridemia

• Fluid collections:

Acute fluid collection: seen early; not encapsulated; asymptomatic; resolve in 1–2 wk

Pseudocyst: ~4 wk after initial attack, encapsulated. No need for Rx if asx (regardless of size/location). If sx → endoscopic (Gastro 2013;145:583) vs. perc/surg drainage.

• Pancreatic necrosis: Nonviable pancreatic tissue. CT-guided FNA if infection suspected.

Sterile necrosis: if asx, can be managed expectantly, no role for Ppx abx

Infected necrosis: most often GN gut organism; high mortality. Rx w/ carbapenem, pip/tazo, or [(3rd gen ceph or FQ) + MNZ]. If stable, defer drainage to >4 wk to allow liquefication & WOPN (qv). If sx or unstable, perc. drainage & minimally invasive surgical debridement or endoscopic necrosectomy superior to open necrosectomy.

WOPN (walled off panc. nec.): fibrous wall surrounds necrosis over ≥4 wk; endoscopic or perc. drainage (preferred over open necrosectomy) if infected or symptomatic

• Peripancreatic vascular complications: pseudoaneurysm, abdominal compartment syndrome, splanchnic venous thrombosis (splenic vein most common site)