Necrotizing pancreatitis happens when pancreatitis inflammation is so severe that it causes tissue death (necrosis). This can cause both short-term and long-term complications. Your healthcare team will manage complications as they arise. If an infection develops, they’ll remove the dead tissue.
Necrotizing pancreatitis is a complication of acute pancreatitis in which part of your pancreas dies. This can happen when pancreatitis is very severe. Pancreatitis is inflammation and swelling in your pancreas, usually in response to an injury or toxins. Severe inflammation can stop the blood flow to your pancreas tissues (ischemia), causing tissue death (necrosis). This is a serious development.
Your healthcare team will need to keep you in the hospital for a while to watch out for further complications that can develop. The most urgent of these is infection. If bacteria come to feast on the dead tissue, they could quickly multiply and spread through your body. This could lead to organ failure and even death. In this event, your healthcare team will likely need to remove the dead tissue.
Necrotizing pancreatitis occurs in approximately 20% of acute pancreatitis cases. In the U.S., acute pancreatitis leads to about 275,000 hospital stays each year.
Advertisement
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
The first symptoms of necrotizing pancreatitis are those of acute pancreatitis, including:
As pancreatitis becomes more severe, you might develop:
The causes of necrotizing pancreatitis happen in stages. It begins with acute pancreatitis that becomes severe, then ischemia sets in, and finally, necrosis develops. Each of these events has its own causes.
The most common cause of severe acute pancreatitis is gallstone disease when a gallstone obstructs your pancreatic duct. This is also called gallstone pancreatitis. The second leading cause is alcohol use.
Inflammation is your body’s response to injury and an attempt to repair the damage. But sometimes the inflammatory response is so severe, it does its own damage.
It’s not always clear why some people have a stronger inflammatory response than others. But it’s clear that this has a snowball effect within your pancreas.
Severe inflammation creates so much pressure that it activates the pancreatic enzymes within your pancreas tissues. These digestive enzymes are usually inactive until they reach your digestive system. When they activate, they begin to digest your pancreas.
This ongoing injury to your pancreas continues to escalate pancreatitis. Eventually, swelling in your pancreas compresses the blood vessels, reducing blood supply to the tissues.
Another possible contributing factor is systemic inflammatory response syndrome (SIRS). This is a whole-body inflammatory response that can cause an overall drop in blood pressure and blood flow.
Lack of blood flow (ischemia) causes tissue death (necrosis). Digestion by pancreatic enzymes probably also contributes to necrosis.
Advertisement
Short-term complications of necrotizing pancreatitis may include:
Long-term consequences of necrotizing pancreatitis may include:
Healthcare providers diagnose necrotizing pancreatitis after diagnosing acute pancreatitis. It takes at least three to five days from the onset of pancreatitis for visible signs of necrosis to appear. If you have signs or symptoms of severe pancreatitis several days after the initial onset, your provider will look for necrosis on a contrast-enhanced CT scan (computed tomography scan) or MRI (magnetic resonance imaging). They’ll also look for other complications, like fluid collections.
Advertisement
Your treatment will depend on whether or not you develop an infection or other complications. When pancreatic necrosis is sterile and doesn’t cause symptoms, healthcare providers treat it conservatively with supportive care. When signs of infection or other complications develop, healthcare providers intervene as necessary. They’ll attempt to remove the necrotic tissue by minimally invasive methods before resorting to surgery.
Supportive care for sterile necrotizing pancreatitis includes:
Most uncomplicated cases will resolve with supportive care alone. Your healthcare team will keep a close eye on your condition during this time. They’ll monitor your vital signs, your intra-abdominal pressure and your complete blood cell count (CBC) to watch for signs of possible complications. If infection or organ failure develops, they’ll offer life support or other interventions as necessary.
When signs of infection appear, your healthcare team will immediately start you on antibiotics and then make plans to remove the necrotic tissue if they can. They’ll begin with the least invasive method possible and step up their methods as needed.
Methods include:
Survival rates differ depending on how much necrosis you have, whether you develop an infection or organ failure, and how you respond to treatment. If it affects less than 30% of your pancreas, mortality rates are less than 15%. The same is true if you have necrosis without any infection. If it affects more than 50% of your pancreas, or if you develop an infection or organ failure, mortality rates rise to over 30%.
At your follow-up appointment, your healthcare provider will ask you about any continuing or new symptoms. Long-term complications can develop later after treatment for necrotizing pancreatitis. If you have symptoms, they might recommend labs or imaging tests to check on them. You might need additional treatment for complications, and the treatment might be short-term or long-term.
A note from Cleveland Clinic
Necrotizing pancreatitis is a serious escalation of acute pancreatitis. While most people recover from acute pancreatitis with only supportive care, those who develop severe pancreatitis and necrosis will need extended and intensive care. You’ll need a multitasking healthcare team to monitor your condition and possible complications. You might need interventions or surgery, and possibly follow-up care.
Last reviewed on 12/11/2023.
Learn more about the Health Library and our editorial process.
Advertisement
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy