What Is Necrotizing Pancreatitis and How Is It Treated?

The pancreas is a glandular organ located on the right side of the abdomen, just behind the stomach. The food you consume is converted into energy for the body cells through the action of the pancreas.

This organ releases certain enzymes and hormones that play important roles in the digestive process as well as the regulation of blood sugar. These pancreatic secretions may be released into the bloodstream or other ducts. For instance, the pancreatic cells produce insulin, which enters the blood directly to control glucose levels.

However, the digestive enzymes produced in the pancreas are released into the small intestine, where they become active and start breaking down the food components.

If these digestive enzymes become active within the pancreas itself, they can damage the pancreatic cells.

What Is Necrotizing Pancreatitis?

Pancreatitis occurs when, instead of the normal release of enzymes from the pancreas into the intestine, there is a blockage or physiological process that leads to the release of these enzymes within the pancreatic ducts themselves, causing irritation to the normal pancreatic cells. 

The corrosive action of these enzymes on the pancreatic tissue triggers inflammation, which is referred to as pancreatitis. Necrotizing pancreatitis occurs when this inflammatory process results in the death of cells within the pancreas.

Pancreatitis can be chronic or acute. Acute pancreatitis is characterized by the sudden onset of pancreatic inflammation, which usually resolves in a few days or weeks, but chronic pancreatitis is more long term.

Necrotizing pancreatitis is a severe subtype of acute pancreatitis and is related to high rates of morbidity and mortality.

Prevalence of Necrotizing Pancreatitis

Pancreatitis can affect people of all ages, but it is more prevalent in men than in women. The incidence of this disease is on the rise globally, particularly in the United States.

In fact, acute pancreatitis has emerged as the most common gastrointestinal cause of hospitalization in the United States, with nearly 270,000 admissions every year.

Most cases of acute pancreatitis are self-resolving and manifest mild symptoms with rarely any long-term complications. However, 15%–25% of the cases can take a turn for the worst and result in cell death (necrosis) or infection, triggering serious complications in about 10% to 30% patients. (1)

How Serious Is Necrotizing Pancreatitis?

Necrotizing pancreatitis is a cause for concern as the important function of the pancreas to digest food and release hormones may be thwarted due to the inflammatory process and cell death within the pancreas. 

Main Causes of Necrotizing Pancreatitis

More than 90% of the pancreatitis cases result from gallstones, particularly in developed countries. (2) Gallstones are also primarily responsible for necrotizing pancreatitis.

Other less common causes of pancreatitis include:

Common Symptoms of Necrotizing Pancreatitis

Symptoms of necrotizing pancreatitis could include:

• Severe acute abdominal pain, which may radiate to the back and may be relieved by bending forward in a knee-to-chest position
• Fever
• Distended or swollen abdomen
• Nausea and vomiting

Necrotizing pancreatitis calls for withholding the oral intake of food and fluids, which may cause:

If the pancreas hemorrhages, other signs, such as Grey Turner’s sign (bruising of the flank) and Cullen’s sign (periumbilical bruising), may be seen.

Medical Treatment for Necrotizing Pancreatitis

Treatment for necrotizing pancreatitis involves the following steps:

1. Treating the underlying pancreatitis
2. Treating the dead/infected pancreatic tissue
3. Treating the sepsis

Most cases of necrotizing pancreatitis warrant conservative treatment that majorly focusses on:

• Supportive care measures to make the condition bearable, including nutritional assistance and pain management
• Preventing further infection of necrosis of pancreatic tissue
• Preventing other complications

The standard treatment of pancreatitis includes:

• Bowel rest
• Maintaining the patient in NPO (nothing per os), which essentially means consuming nothing by mouth (food and fluids)
• Administration of IV fluids
• Administration of antibiotics, if an infection is suspected
• Administration of pain medication

If these preliminary measures fail to control or reverse pancreatic necrosis, more invasive methods such as surgery are needed to remove the dead pancreatic tissue.

The surgery typically begins with draining the fluids from your pancreas through a catheter, followed by an endoscopic necrosectomy to extract the damaged tissue. Surgery becomes all the more necessary if the necrotic tissue becomes infected.

Why Do Doctors Delay Treating Necrotizing Pancreatitis Until a Later Stage?

Treatment interventions have a higher success rate and a better chance to avert complications when administered at a later stage of the disease.

Delayed treatment is preferred in most cases of necrotizing pancreatitis, provided that the condition of the patient is stable, and the symptoms are fairly manageable.

The doctor will start treatment a few days after the symptoms emerge so that the disease becomes more clearly defined. But emergency treatment may be needed if the patient becomes extremely sick such that the symptoms become unbearable.

Diagnosing Pancreatitis

Acute pancreatitis is easier to diagnose than chronic pancreatitis. Chronic pancreatitis sets in more gradually and with milder symptoms.

The diagnostic process basically involves:

• Inquiring about the patient’s signs and symptoms
• Reviewing the patient’s medical history
• Physical examination
• Laboratory tests, typically a blood test, to determine the level of certain digestive enzymes released by the pancreas
• Imaging tests, to determine the presence and extent of pancreatic necrosis or pancreatic tissue death

Necrotizing pancreatitis can be diagnosed via laboratory studies demonstrating elevation in pancreatic enzymes (amylase or lipase) and imaging modalities, including CT scan, MRI scan, ultrasound, and endoscopic retrograde cholangiopancreatography (ERCP).

Preventing Necrotizing Pancreatitis

Early-stage treatment of pancreatitis can keep it from worsening into a more severe and aggressive form of the disease that can induce pancreatic necrosis or the death of pancreatic tissue. If you handle the condition well from the start, it is less likely to cause complications such as necrotizing pancreatitis later.

Anyone who is diagnosed with acute or chronic pancreatitis runs the risk of developing pancreatic necrosis. So, if you have pancreatitis, you must familiarize yourself with the signs of pancreatic tissue death to catch and treat it early.

Consult your doctor immediately for the necessary treatment to contain the spread of necrosis. However, there is little you can do to prevent pancreatitis that is rooted in genetic issues such as cystic fibrosis.

People diagnosed with pancreatitis are routinely recommended the following measures to prevent pancreatic necrosis:

People at Risk of Necrotizing Pancreatitis

There is a greater incidence of pancreatic necrosis in acute pancreatitis as opposed to chronic pancreatitis.

Thus, people who suffer from sudden but temporary inflammation in the pancreas are more likely to suffer from necrotizing pancreatitis than those who suffer from long-lasting pancreatic inflammation.

Other factors that can increase your risk of developing necrotizing pancreatitis include:

• If you suffer from gallstones or have a family history of gallstones, which can block the flow of digestive enzymes
• If you are obese, since excessive body fat is known to aggravate the severity of acute pancreatitis and thereby cause pancreatic necrosis (3)
• If you consume excessive amounts of alcohol, which is regarded as one of the most common causes of pancreatitis (4)  
• If you are a smoker, as this habit can increase the risk of pancreatic cancer in people with pancreatitis (5)

Possible Complications of Necrotizing Pancreatitis

 Necrotizing pancreatitis can lead to the following complications:

1. Infection

The most common complication associated with necrotizing pancreatitis is infection. Dead pancreatic tissue can invite bacterial overgrowth, usually 2–3 weeks after the first sign of pancreatic necrosis.

2. Sepsis

If the infection remains unchecked or untreated, it can spread to the bloodstream and can result in a potentially fatal condition called sepsis.

Sepsis is far more threatening when it co-occurs with pancreatitis. The entry of the bacteria into the bloodstream can send your entire body into shock and inhibit blood flow to the major organs.

Blood supplies oxygen and nutrients to the vital organs, keeping them healthy and functioning. In the absence of proper blood supply, these organs become susceptible to temporary or permanent damage.

In some cases, the damage can be so severe that it leads to complete organ failure or death. Other less life-threatening complications associated with necrotizing pancreatitis include:

When to See a Doctor

You should be seen for an in-person examination if you have symptoms of severe abdominal pain and for routine evaluation by a family practice physician and gastrointestinal specialist for currently diagnosed pancreatitis.

Final Word

Inflammation of the pancreas can lead to significant complications, including cancer, if left uncontrolled. When acute pancreatitis becomes necrotizing pancreatitis, invasive treatment (surgery) becomes more likely.

If you suffer from pancreatitis, you should be vigilant of your health and monitor for gallstones, hyperlipidemia, and diabetes. Eat a low-fat diet, drink ample fluids, and take supplemental pancreatic enzymes as needed.