Untreated Pancreatitis: 6 Possible Scenarios.
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Summary: what happens if pancreatitis is left untreated?
Acute pancreatitis is a serious acute inflammatory condition that may progress into a life-threatening condition if left untreated.
Pancreatitis can be difficult to diagnose at first (especially if the inflammation is mild).
Today, well will dive into the possible outcomes of untreated pancreatitis.
Once suspected, you should seek emergency medical help. Ignoring pancreatitis treatment might lead to life-threatening complications.
If pancreatitis is left untreated, the risk of complications such as sepsis, bleeding, and organ failure will be higher. Consequently, the risk of death will be higher without treatment.
Possible outcomes of untreated acute pancreatitis:
- Spontaneous resolution.
- Uncontrollable pain.
- Hemorrhage (retroperitoneal hemorrhage).
- Hypovolemic shock (severe dehydration).
- Sepsis (and septic shock).
- Temporary organ failure.
- Persistent organ failure (single or multi-organ failure).
- Other complications.
Prognosis of pancreatitis with optimal treatment (reference):
- 75-80% will have mild to moderate (uncomplicated) pancreatitis.
- 15-25% will have severe necrotizing pancreatitis.
- Overall mortality with acute pancreatitis is less than 5% (with optimal treatment).
1. Spontaneous resolution of untreated acute pancreatitis.
There is no specific treatment for pancreatitis that directly cures the inflammation. However, fluid therapy and antibiotics are extremely important treatments for pancreatitis to prevent complications.
Patients who don’t receive treatment for acute pancreatitis are at higher risk of complications and death.
However, some patients may undergo spontaneous resolution of the disease without treatment. The time it takes for the pancreas to heal is variable.
With optimal treatment, symptoms of acute pancreatitis often resolve within a week or two. Spontaneous resolution in patients with untreated pancreatitis may also occur but:
- It takes more time to heal
- The incidence of complications is higher.
The incidence of complications in patients who receive optimal treatment for acute pancreatitis is about 20% (one in every five patients).
No research data for the incidence of complications among patients with untreated pancreatitis. However, the incidence is often higher, and the complications may be fatal if left untreated.
Common complications include (reference):
- Pancreatic pseudocyst (a collection of pancreatic fluid during acute pancreatitis. may cause severe symptoms, and some pseudocysts require drainage by surgery or endoscopy).
- Pleural effusions.
- Sepsis and septic shock (bacteria or their toxins lead into the blood and cause low blood pressure).
- Internal bleeding.
- Fluid collections around the pancreas.
- Organ failures (for example, respiratory failure, renal failure).
- Higher risk of diabetes.
On the other hand, 75-80% of patients with acute pancreatitis may undergo resolution of the inflammation with significant local or systemic complications.
Who are at higher risk of complications in untreated pancreatitis?
- Older ages (especially those who are above 60).
- Alcohol-induced acute pancreatitis is more likely to cause severe and complicated pancreatitis.
- Patients with chronic diseases, especially chronic liver failure (liver cirrhosis) or chronic renal failure (dialysis patients).
These groups are at higher risk of complicated acute pancreatitis, especially if left untreated.
2. Intolerable pain.
Pain is one of the cardinal features of acute pancreatitis. In addition, pain is the symptom that drives patients to see medical care.
The magnitidute of pain in acute pancreatitis is severe. Pain can be extreme and intolerable if left untreated.
The pain in pancreatitis is often persistent and doesn’t go away until inflammation resolves. In addition, untreated pain can contribute to worsening pancreatitis by inducing nausea and vomiting.
Some experts believe untreated pancreatitis pain can contribute to hemodynamic instability (low blood pressure or shock) (reference).
Pain is often more severe in cases of acute pancreatitis due to gallstone disease. Because pancreatitis pain is severe, doctors often prescribe very potent analgesics such as opioid analgesics.
About 13% of patients with severe acute pancreatitis (SAP) may experience bleeding as a disease complication.
The bleeding can be either:
- Intra-luminal (bleeding to the gastrointestinal tract (which manifests as a blackish stool, vomiting of blood, or passage of dark blood to the nasogastric tube).
- Intra-abdominal (bleeding into the abdominal cavity).
Untreated pancreatitis or delayed treatment (delayed hospital admission) of acute pancreatitis leads to a higher risk of bleeding.
Untreated hemorrhage secondary to acute pancreatitis often leads to life-threatening complications such as:
- Massive blood loss with low blood pressure (hypovolemic shock).
- Severe anemia due to massive loss.
- Death in severe or untreated cases.
Hemorrhagic pancreatitis needs urgent treatment. Any delay in the treatment of such complications is life-threatening.
Treatment options include:
- Blood transfusion replaces the lost amount of blood and prevents shock and severe anemia.
- IV fluid to replace the loss of blood and to prevent dehydration.
- Blocking the bleeding vessel via radiological intervention (embolization).
4. Severe dehydration & hypovolemic shock.
Patients with acute pancreatitis often lose a significant amount of their body fluid. Untreated pancreatitis can lead to serious dehydration and low blood pressure (hypovolemic shock).
Also, severe dehydration may contribute to pancreatic damage during acute pancreatitis (reference).
The causes of severe dehydration with acute pancreatitis include:
- Fluid loss into the abdominal cavity or around the pancreas (peripancreatic fluid collections).
- Internal bleeding or gastrointestinal bleeding.
- Lack of oral intake.
- Persistent vomiting.
- Increased blood calcium (leading to excess fluid loss through urine).
Aggressive intravenous fluid therapy is a cornerstone treatment for patients with acute pancreatitis. Untreated acute pancreatitis patients who fail to receive proper intravenous fluid are more liable to complications such as:
- Severe dehydration.
- Low blood pressure (hypovolemic shock).
- Pre-renal failure (renal failure due to lack of renal perfusion due to dehydration).
- Pancreatic hypoperfusion due to dehydration leads to Aggravation of the pancreatitis inflammation and a higher risk of complications.
- Higher risk of organ failure such as respiratory failure, cardiac ischemia, renal failure, etc.
- Higher risk of death.
Signs of dehydration include:
- Extreme thirst.
- Dry mouth and tongue.
- Scanty, deep yellow urine.
- Scanty tears (dry and sunken eyes).
- Fast heartbeats.
- Confusion, dizziness, and maybe a coma.
5. Organ failure (such as renal or respiratory failure).
Patients with acute pancreatitis may experience systemic complications affecting other body organs.
The cause is the release of activated pancreatic enzymes and inflammatory mediators into the blood circulation.
This systemic inflammatory response syndrome (SIRS) can cause significant organ dysfunction (either temporary or permanent.
The risk of organ failure is greater in patients with untreated pancreatitis or who delay treatments.
Pancreatitis-induced organ failure can be:
- Temporary (less than 48 hours duration): transient deterioration of organ functions such as low oxygen (respiratory failure) or transient renal failure.
- Persistent or permanent (more than 48 hours): severe and persistent organ failure can be persistent, and the condition is often fatal.
Common organ failures associated with untreated acute pancreatitis include:
- Respiratory failure: low oxygen due to induction of a disease called acute respiratory distress syndrome (ARDS).
- Renal failure is characterized by elevated serum urea, creatinine, and sometimes scanty urine.
- Heart problems include slow heartbeats, heart block, or myocardial infarction (death or a part of the heart muscle).
- Diabetes (failure of the pancreas to produce insulin leading to diabetes or even diabetic ketoacidosis (DKA).
6. Other complications of untreated pancreatitis.
The below complications occur in both treated and untreated pancreatitis. However, the risk of complications is often higher in patients with untreated or delayed treatment of pancreatitis.
These complications include (reference):
- Pancreatic pseudocysts
- Thrombosis of the blood vessels (splanchnic veins) surrounding the pancreas.
- Pancreatic necrosis (death of a significant part of the pancreatic tissue due to severe inflammation.
- Pancreatic abscess.
- Death is a consequence of one of the complications listed above.