Necrotizing Pancreatitis

What causes necrotizing pancreatitis?

NP happens when your pancreas gets inflamed or injured, and the pancreatic enzymes leak. This harms the tissues of the pancreas. If this damage can't be reversed, it causes NP. In some cases, the nearby tissue may become infected. This is from bacteria that spread into this dead tissue.

NP may start after an episode of sudden (acute) pancreatitis. People with chronic pancreatitis can also get NP. But this isn’t as common.

Having gallstones and drinking a lot of alcohol are the most common causes of pancreatitis. Some other causes are:

• Trauma of the pancreas
• Pancreatic tumor
• High levels of calcium in your blood
• Very high levels of blood fats (cholesterol, triglycerides)
• Damage to the pancreas from medicines
• Autoimmune diseases
• Conditions that run in your family that harm the pancreas, such as cystic fibrosis and other genetic conditions that cause recurrent pancreatitis

Who is at risk for necrotizing pancreatitis?

You may have a higher risk for NP if you have a health issue that can cause pancreatitis. These include gallstones. You may be able to decrease your risk for NP by treating your health condition. Drinking less alcohol may also lower your risk.

What are the symptoms of necrotizing pancreatitis?

Symptoms of NP may include:

• Gradual or sudden stomach pain that sometimes goes around to your back and is often severe and lasts for days
• Fever
• Swollen belly
• Nausea and vomiting

NP may also cause dehydration and low blood pressure. Complications from NP may cause other symptoms.

How is necrotizing pancreatitis diagnosed?

Your healthcare provider will ask about your health history, symptoms, and other health conditions. They will also give you an exam, focusing on your abdomen.  

To diagnose pancreatitis, your healthcare provider may do tests. These may include:

• Tests that look for high levels of pancreatic enzymes in your blood
• Tests for other substances, including sodium, potassium, and glucose
• Tests to find the cause of the pancreatitis, including tests for blood fats
• Imaging tests, which may include an abdominal ultrasound or CT scan

Your healthcare provider will rule out other causes of your symptoms. They will check you for an ulcer, inflammation of your gallbladder, or pancreatic cancer. Your healthcare provider can often diagnose NP with another imaging test, such as MRI.

Your healthcare provider may also take a sample from the part of your pancreas that has died. Using imaging tests, a healthcare provider uses a fine needle to take a small sample. This sample then goes to a lab. Technicians can tell if the dead tissue shows signs of infection.

How is necrotizing pancreatitis treated?

Treatment often happens in two parts. You will have treatment for pancreatitis and treatment for the part of the pancreas that has died. To treat the pancreatitis, you may need:

• Rest
• IV (intravenous) fluids
• Pain medicines
• Medicines to prevent vomiting

You may also need nasogastric feedings. In nasogastric feeding, you get nutrition in liquid form. You will get it through a long, thin tube. This tubeis put through your nose and into your stomach. You may also not be able to eat or drink anything for a while so that your pancreas can rest. Sometimes the feeding tube is put through your nose into the small intestine. This is called nasojejunal feeding.

If the sample of your pancreas doesn’t show signs of infection, you may not need further treatment. In this case, your healthcare team will monitor your condition. You may need to have another small sample taken from your pancreas. Your healthcare provider may want to recheck you for signs of infection.

If you have signs of infection or lab tests that show infection, you will need antibiotics. You will also likely need to have the dead, infected pancreatic tissue removed.

Your healthcare provider may put a thin tube (catheter) through your abdomen to remove the dead tissue. This is done with the help of medical imaging. Or the area may be taken out endoscopically. This means it will be removed by going into the abnormal tissue of the pancreas through the stomach. Or your provider may reach the tissue through the small intestine or the ducts of the pancreas through the small intestine. In other cases, you may need surgery to remove the area. This is often done after other techniques have not worked.

If your health is stable, your healthcare provider may delay these treatments for a few weeks. That’s because the risk for complications decreases when it’s done later. But if you are very sick, you may need emergency treatment to remove the dead, infected part of your pancreas.

What are the possible complications of necrotizing pancreatitis?

The main complication is infection. It affects many people with NP. This is more likely to happen 2 to 3 weeks after NP first appears.

Infection can sometimes lead to sepsis. In this illness, your body has a severe reaction to bacteria in your bloodstream. Sepsis can lead to shock. This reduces blood flow to your major organs. This can cause temporary or permanent damage to your organs. Sepsis can sometimes lead to death.

Your healthcare team will treat early signs of sepsis to give you the best chance of getting better. You may need IV fluids, antibiotics, and breathing support. They will also treat early signs of infection. This is to help keep sepsis from happening in the first place.

Key points about necrotizing pancreatitis

• NP is a health problem in which part of your pancreas or tissues around it die. This happens after inflammation or injury. It can sometimes cause serious infections.
• Having gallstones and drinking a lot of alcohol are the most common causes of pancreatitis, including NP.
• Symptoms of NP may include stomach pain and vomiting.
• This condition is often diagnosed with CT or another imaging test.
• Your treatment may depend on whether the dead part of your pancreas shows signs of infection. Some people with NP need surgery to remove the dead tissue.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Jen Lehrer MD

Medical Reviewer: Rita Sather RN

Medical Reviewer: L Renee Watson MSN RN

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