- Ischaemia and autodigestion lead to necrosis of peri-pancreatic fat and surrounding tissue· Appearance changes over time:
- Early: appears as a diffuse semi-solid mass with no obvious demarcation
- Late (>4 weeks): develops a fibrinous wall making it more amenable to intervention·
- Infected necrosis is associated with significant morbidity and mortality
- Image-guided needle aspiration of pancreatic tissue is required to confirm the diagnosis
- Proven infection necessitates drainage/debridement
- Organisms are usually gut-derived:
- Common pathogens – Escherichia coli, Bacteroides, and Enterococcus
- Rarer pathogens -Staphylococcus and Pseudomonas
- Fungal infection rare but more common when prophylactic antibiotics are given