What is necrotizing pancreatitis?

Necrotizing pancreatitis (NP) is a health problem in which part of your pancreas dies. This is because of severe inflammation or injury. If the dead tissue gets infected, it can cause serious issues.

The pancreas is an organ that sits behind your stomach. It makes fluids that flow through a duct into the small intestine. These fluids help you digest food. The pancreas also releases hormones, including insulin, to help control blood sugar.

Pancreatitis is inflammation of the pancreas. When the pancreas gets inflamed, it may leak digestive enzymes into the pancreas itself. This harms the pancreas. This can lead to pancreatitis.

When this damage is severe, parts of your pancreas may not get enough blood and oxygen to survive. NP happens when a part of the pancreas or the tissue around it dies from inflammation.

Only some people with pancreatitis get necrotizing pancreatitis. Pancreatitis is a fairly common condition. It’s been on the rise lately. It can affect people of all ages.

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.

• A 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. These include cystic fibrosis and other genetic conditions that cause recurrent pancreatitis.

• Abdominal surgery.

• Infections.

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. One example is 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.

• A fever.

• A swollen belly.

• Nausea and vomiting.

• An increased heart rate.

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

How is necrotizing pancreatitis diagnosed?

Your health care 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 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 a CT scan.

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

Your provider may also take a small tissue sample from the part of your pancreas that has died. Using imaging tests for guidance, a provider uses a very thin needle to take a small sample. This sample is examined at a lab under a microscope for a diagnosis.

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.

• I.V. (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 tube is 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 health care team will keep track of your condition. You may need to have another small tissue sample taken from your pancreas at another time to recheck 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.

To treat the part of the pancreas that has died, you may have:

• Endoscopic necrosectomy. Your health care provider may put a thin tube (catheter) through your abdomen to remove the dead tissue. This is done with the help of medical imaging. The tissue 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.

• Surgical necrosectomy. Necrotic tissue is removed surgically through the abdomen. This is often done after other methods have not worked.

If your health is stable, your health care 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 health care team will treat early signs of sepsis to give you the best chance of getting better. You may need I.V. 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 common causes of pancreatitis, including NP.

• Symptoms of NP may include stomach pain and vomiting.

• This condition is often diagnosed with CT scans or other imaging tests.

• 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

Here are some tips to help you get the most from a visit to your health care 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 don't 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 health care provider if you have questions, especially after office hours and on weekends.