Inflammation of the Pancreas: Complications

The following are the most important diseases or complications that can be caused by pancreatitis (inflammation of the pancreas):

Acute pancreatitis (AP)

Local sequelae and complications of acute pancreatitis may include:

  • Vascular erosion (Latin: arrodere – (to) gnaw) with acute bleeding into the abdominal cavity.
  • Necrosis (tissue death; see below infections).
  • Fistula formations due to erosion of small or large intestine (late complication).
  • Pancreatic abscess
  • Pancreatic pseudocysts (late complication)
  • Rupture

Systemic sequelae and complications (including late complications) of acute pancreatitis may include:

Chronic pancreatitis

Consequential diseases and complications of chronic pancreatitis may include:

  • Exocrine pancreatic insufficiency (EPI; disease of the pancreas associated with inadequate production of digestive enzymes) → steatorrhea (fatty stools), weight loss
  • Endocrine pancreatic insufficiency (pancreas produces less or no more insulin) → insulin deficiency diabetes (patients are prone to hypoglycemia/ hypoglycemia) [about 80% of patients].
  • Chronic pain (most common and the most debilitating aspect of chronic pancreatitis).
  • Stenosis symptoms (pancreatic swelling and pancreatic duct stenoses, peripancreatic swelling with narrowing of choledochal (common bile duct)/bile duct compression, duodenum (duodenal)/duodenal stenoses, colon (large intestine), and pleural effusion (abnormal accumulation of fluid in the pleural cavity) and ascites (abdominal fluid))
  • Strictures in the pancreatic or bile duct with recurrent pancreatitis.
  • Gastrointestinal bleeding
  • Icterus
  • Bone pain due to fatty tissue necrosis
  • Osteoporosis (bone loss)
  • Pancreatic cancer (within 20 yrs, the risk is increased by 4% (= 16-fold increased compared to the normal population; in patients who also smoke 25-fold); 69-fold increased risk in hereditary (“hereditary”) pancreatitis).
  • Steatorrhea
  • Subcutaneous fat necrosis

Summary of sequelae of acute and chronic pancreatitis:

Respiratory System (J00-J99).

Eyes and eye appendages (H00-H59).

  • Retinopathy (disease of the retina) with sudden blindness, but rare.

Blood, blood-forming organs – immune system (D50-D90).

  • Atraumatic splenic rupture (rupture of the spleen without trauma/accident) in the setting of necrotizing pancreatitis of the tail of the pancreas (very rare)
  • Hemorrhage, unspecified
  • Disseminated intravascular coagulation (synonyms: disseminated intravascular coagulopathy (from Latin : disseminated = “scattered”; intravascular = “in the vessel”; coagulation = clotting) or DIC (as an abbreviation of the English term Disseminated Intravascular Coagulation) – acquired life-threatening condition in which clotting factors are depleted by excessive blood clotting in the vascular system, resulting in a tendency to bleed.

Endocrine, nutritional and metabolic diseases (E00-E90).

Skin and subcutaneous (L00-L99)

  • Subcutaneous fat necrosis – painful, red nodules in the lower extremities.

Cardiovascular system (I00-I99).

  • Hypotension (low blood pressure)
  • Portal vein or splenic vein thrombosis
  • Sudden cardiac death

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

  • Endocrine pancreatic insufficiency (pancreatic weakness) with development of insulin deficiency diabetesVascular erosion (Latin: arrodere – (to) gnaw) of the pancreas with acute bleeding into the abdominal cavity
  • Pancreatic abscess (purulent pancreatitis).
  • Pancreatic fistula formations due to erosion of small or large intestine (late complication).
  • Pancreatic pseudocyst
  • Rupture (lat. ruptura tearing, breakthrough from rompere tear, English rupture) of the pancreas (pancreas) – tearing or rupture.
  • Fat necrosis – e.g. in the bones.

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Gastritis (inflammation of the gastric mucosa).
  • Mesenteric infarction (intestinal infarction) – thrombosis (blockage) of a blood vessel supplying the intestine
  • Paralytic ileus (intestinal obstruction due to intestinal paralysis).
  • Steatorrhea – increased excretion of fat with the stool.
  • Ulcer (ulcer)

Musculoskeletal system and connective tissue (M00-M99)

  • Osteoporosis (bone loss)

Neoplasms – tumor diseases (C00-D48)

Psyche – nervous system (F00-F99; G00-G99)

  • Psychosis

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)

  • Chronic pain
  • Icterus (jaundice)
  • Cachexia (emaciation, very severe emaciation).
  • Systemic inflammatory response syndrome (SIRS; life-threatening organ dysfunction due to a dysregulated body response to infection):
    • Body temperature: <36°C or >38°C.
    • Heart rate: > 90 beats/min
    • Respiratory rate: > 20 breaths/min
    • Arterial partial pressure of carbon dioxide (p aCO 2): < 32 mmHg
    • Leukocyte count (white blood cell count): > 12,000/mm3 or < 4,000/mm3.

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Acute tubular necrosis (ATN) – renal disease.
  • Azotemia (accumulation of harmful breakdown products of protein metabolism).
  • Renal artery and/or renal vein thrombosis.
  • Oliguria (decreased urine production)

Prognostic factors

The following are the modified Glasgow criteria. These rate acute pancreatitis as severe if at least three of the following criteria are present:

  • Age >55 years
  • Laboratory parameters:
    • Partial pressure of oxygen (pO2; PaO2) < 60 mmHg.
    • Leukocytes > 15,000/μl
    • Calcium < 2 mmol/L
    • Urea > 16 mmol/L
    • Lactate dehydrogenase (LDH) > 600 IU/L
    • Aspartate aminotransferase (AST; GOT) > 200 IU/L
    • Albumin < 32 g/L
    • Glucose > 10 mmol/L

Specific patient characteristics or criteria according to the American College of Gastroenterology (ACG) guidelines who are at increased risk for a severe course of acute pancreatitis:

Features Description
Patient characteristics
  • Age > 55 years
  • Body mass index (BMI) > 30 kg/m2
  • Disturbance of consciousness
  • Comorbidities (concomitant diseases)
SIRS criteria See below “Systemic inflammatory response syndrome (SIRS)”/Symptoms – Complaints.”
Laboratory parameters
  • BUN > 20 mg/dl, increasing BUN* .
  • Hematocrit > 44%, rising hematocrit.
Imaging criteria
  • Pleural effusions
  • Pulmonary infiltrates
  • Multiple or marked extrapancreatic (“outside the pancreas”) fluid and necrosis accumulations

* Urea x 0.46 = urea-N (English blood urea nitrogen), usually abbreviated BUN; here, only the nitrogen contained in the urea is given, not the urea).