Etiology.—The etiology is somewhat doubtful, though acute pancreatitis not terminating in death might be expected to result in the suppurative. Trauma, errors in diet, dissipation, and debauchery, are suggested as predisposing causes. An extension of infectious material from neighboring parts through the ducts would give rise to the suppurative form.
Pathology.—The organ is generally enlarged, and abscesses of various sizes may be found throughout the organ, or one large abscess may be found, with marked destruction of tissue. The suppurative process may extend to the peripancreatic tissue, or perforation into the stomach, duodenum, or peritoneum, may occur.
Fat necrosis is rare in suppurative pancreatitis; the spleen is but little enlarged, though abscess of the liver is not uncommon.
Symptoms.—The disease may be ushered in suddenly, as in the acute form, with intense pain in the epigastrium, vomiting, and more or less prostration. At the end of forty-eight or seventy-two hours, rigors occur, followed by fever of a septic type, and the tympanitic condition of the epigastrium may extend to the entire abdomen. Constipation may give way to diarrhea. Hiccough, followed by coma and death during the first week is the rule. Occasionally, however, the disease is prolonged for three or four weeks, the symptoms of septico-pyemia being present, the patient finally dying of exhaustion.
Diagnosis.—The diagnosis is generally made, only post-mortem, though the sudden onset, with intense pain in the epigastric region, vomiting and prostration, followed by pronounced evidence of sepsis, would suggest the character of the disease.
Prognosis.—The disease almost invariably ends fatally. Should the diagnosis be made early, surgical interference might result favorably in a very few cases.
Treatment.—The treatment will be surgical and antiseptic. Echinacea would be an important remedy, though the sulphites, chlorates, and mineral acids would be indicated in many cases.