Indian Journal of Pathology and Microbiology

IMAGE
Year
: 2009  |  Volume : 52  |  Issue : 4  |  Page : 573--574

Pancreatic abscess secondary to gall stones caused by Escherichia coli


VP Baradkar, M Mathur, S Kumar 
 Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai - 400 002, India

Correspondence Address:
V P Baradkar
Department of Microbiology, L.T.M.M.C and L.T.M.G.H, Sion, Mumbai - 400 022
India




How to cite this article:
Baradkar V P, Mathur M, Kumar S. Pancreatic abscess secondary to gall stones caused by Escherichia coli.Indian J Pathol Microbiol 2009;52:573-574


How to cite this URL:
Baradkar V P, Mathur M, Kumar S. Pancreatic abscess secondary to gall stones caused by Escherichia coli. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Aug 5 ];52:573-574
Available from: http://www.ijpmonline.org/text.asp?2009/52/4/573/56162


Full Text

Pancreatic abscess is defined as an acute inflammatory process of the pancreas, with variable involvement of other regional tissues or remote organ system. [1] The causes of pancreatic abscess and acute pancreatitis include cholelithiaisis, ethanol abuse, trauma, metabolic causes such as hypercalcemia, diabetic ketoacidosis, uremia, hyperparathyroidism, autoimmune diseases and idiopathic causes. [1] Acute pancreatitis following pancreatic abscess is classified as either mild (85% cases) or severe (15% cases). [1],[2],[3],[4],[5] The organisms reported from cases of pancreatic abscesses include Escherichia coli,Klebsiella species, Proteus species, Pseudomonas species, Enterobacter species, Candida species, Staphylococcus aureus, Enterococcus fecalis, Citrobacter species, Bacteroides species, Haemophilus influenzaeand Mycobacterium tuberculosis. [1],[2],[3],[4],[5] Specific treatment for acute pancreatitis currently does not exist and management is still supportive and varies from case to case.

Here we report a case of pancreatic abscess due to E. coli, secondary to bile stones, which was managed successfully with supportive therapy, antibiotics, endoscopic retrograde cholangiopancreatography (ERCP) and surgical drainage.

A 36-year-old male was admitted for evaluation with a one-month history of fever, abdominal discomfort, anorexia, nausea and vomiting. The patient was non-diabetic and there was no history of any major illness in the past. On examination the patient was febrile, with a pulse rate of 100/min, blood pressure of 130/80 mm/Hg. There was no pallor, icterus or cyanosis. The findings of the cardio-respiratory and nervous system examination were within normal limits. There was no abdominal distension or any obvious organomegaly but a mild tenderness was noted in the epigastric region. Total leukocyte counts was 9800/ mm 3 , with 78% polymorphs and 22% lymphocytes. The erythrocyte sedimentation rate was slightly raised at 20 mm at the end of one hour. The liver and renal function tests were within normal limits. The level of serum amylase was raised, at 297.76 IU/ L (normal upto 220 IU/L) and serum lipase was 797.07 U/L (normal value for adults E. coli which was sensitive to amikacin, amoxycillin + alavulanic acid, ciprofloxacin, cefotaxime. The patient was started on Cefotaxime which was continued for two weeks. ERCP and sphincterotomy was done and the bile calculi were removed. Percutaneous drainage was performed for two weeks. The patient meanwhile showed signs of recovery with complete remission of fever and subsidence of the epigastric pain. The patient was later discharged after two weeks on oral ciprofloxacin and was asked to follow up on outdoor patient basis. On the last follow-up, one month after admission the patient was doing well and there were no symptoms of any relapse during this period.

Cholelithiaisis-associated pancreatitis accounts for approximately 45% of cases of pancreatitis followed by ethanol abuse for 35%, other causes for up to 10% and in up to 10% no cause may be found (idiopathic). In the present case, multiple gallstones acted as the cause of pancreatitis and abscess formation. There was no other metabolic abnormality observed. The clinical presentation of pancreatitis varies from case to case, with epigastric pain, nausea and vomiting being the commonest symptoms as observed in the present case. Respiratory signs of pleural effusion and basal collapse are found in 10-20% of patients as observed in the present case. [1],[3],[5]

Blood/ plasma amylase levels are elevated which confirms the diagnosis. Plasma lipase levels are increased and are a specific marker of pancreatitis. It differentiates acute pancreatitis from other causes of hyperamylasemia. This was observed in the present study. The diagnosis was performed by USG and CT scanning followed by diagnostic aspiration which yielded E. coli. Our patient responded to Cefotaxime along with gallstone removal by ERCP, sphincterotomy. The percutaneous drain was kept for two weeks.

Early diagnosis and prompt treatment of pancreatitis or pancreatic abscess is necessary to prevent any associated morbidity or mortality.

References

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