Bacterial, Granulomatous, Viral and Parasitic Lesions of the Pancreas

  • Alan H. Cruickshank
  • Emyr W. Benbow


Primary bacterial inflammation of the pancreas is rare, but if acute pancreatitis has caused necrosis of a part of the pancreas, or if a pseudocyst has been formed, bacterial infection may convert the necrotic tissue or the pseudocyst into an abscess. The origin of the organisms, and the route by which they reach the pancreas, may vary from patient to patient, and may included blood-borne infection, lymphatic or direct spread from the colon or infection from the biliary tract. Direct penetration of the wall of the transverse colon by its normal bacterial flora is the most probable route; intestinal organisms are those that are most commonly identified in pus from pancreatic abscesses. A mixture of organisms was present in 13 of the 32 pancreatic abscesses studied by Altemeier and Alexander (1963).


Human Immunodeficiency Virus Acute Pancreatitis Chronic Pancreatitis Pancreatic Duct Hydatid Cyst 
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  1. Altemeier WA, Alexander JW (1963) Pancreatic abscess: a study of 32 cases. Arch Surg 87:80–89PubMedCrossRefGoogle Scholar
  2. Anderson GS, Peebles Brown DA (1959–1960) A case of hydatid cyst of the pancreas. Br J Surg 47:147–149PubMedCrossRefGoogle Scholar
  3. Auerbach O (1944) Acute generalised miliary tuberculosis. Am J Pathol 20:121–136PubMedGoogle Scholar
  4. Baker RD (1942) Tissue reactions in human blastomycosis: an analysis of tissue from twenty-three cases. Am J Pathol 18:479–489PubMedGoogle Scholar
  5. Bernstein A (1940) Infectious mononucleosis. Medicine 19: 85–159CrossRefGoogle Scholar
  6. Berson BD, Mendelson DS, Janus CL (1989) Tuberculous abscess of the pancreas in AIDS: CT findings. Mt Sinai J Med 56:297–299PubMedGoogle Scholar
  7. Birch-Hirschfeld FV (1875) Beitrage zur pathologischen Anatomie der hereditaren Syphilis neugeborner, mit besonderer Berucksichtigung einer Veranderung der Bauchspeicheldruse. Arch Heilkunde 16:166–178Google Scholar
  8. Bollaert PE, Maurizi M, Laprevote-Heully MC, Lambert H, Larcan A (1986) Pancréatite aigue nécrotico-hemorrhagique au cours d’une maladie des légionnaires. Presse Med 15:1732PubMedGoogle Scholar
  9. Bolooki H, Jaffe B, Gliedman ML (1968) Pancreatic abscesses and lesser omental sac collections. Surg Gynecol Obstet 126:1301–1308PubMedGoogle Scholar
  10. Boon AP, O’Brien D, Adams DH (1991) 10-year review of invasive aspergillosis detected at necropsy. J Clin Pathol 44:452–454PubMedCrossRefGoogle Scholar
  11. Bostrom K (1968) Patho-anatomical findings in a case of mumps with pancreatitis, myocarditis, orchitis, epididymitis and seminal vesiculitis. Virchows Arch [A] 344:111–117Google Scholar
  12. Boyd JF (1969) Salmonella typhimurium, colitis, and pancreatitis. Lancet ii: 901–902CrossRefGoogle Scholar
  13. Bricaire F, Marche C, Zoubi D, Saimot AG, Regnier B (1988) HIV and the pancreas. Lancet i: 65–66CrossRefGoogle Scholar
  14. Brivet F, Coffin B, Bedossa P et al. (1987) Pancreatic lesions in AIDS. Lancet ii: 570–571CrossRefGoogle Scholar
  15. Byrom NP, Walls J, Mair HJ (1979) Fulminant psittacosis. Lancet i:353–356CrossRefGoogle Scholar
  16. Chan PH, Teoh TB (1967) The pathology of Clonorchis sinensis infestation of the pancreas. J Pathol Bacteriol 93:185–189PubMedCrossRefGoogle Scholar
  17. Cope VZ (1938) Actinomycosis. Oxford University Press, LondonGoogle Scholar
  18. Cope VZ (1949) Visceral actinomycosis. Br Med J ii: 1311–1316CrossRefGoogle Scholar
  19. Cosme A, Drive V, Ojeda E, Aramburu V, Irazusta M, Arenas JI (1987) Hydatid cyst of the pancreas with spontaneous fistula to the duodenum. Am J Gastroenterol 82:1311–1313PubMedGoogle Scholar
  20. Cox LB, Tolhurst JC (1946) Human torulosis: a clinical pathological and microbiological study with a report of thirteen cases. Melbourne University Press, Melbourne, p 149Google Scholar
  21. Craighead JE (1977) Viral diabetes. In: Volk BW, Wellmann KF (eds) The diabetic pancreas. Baillière Tindall, London, pp 467–488Google Scholar
  22. Crook LD, Johnson FP (1988) Tuberculosis of the pancreas: a case report. Tubercle 69:148–151PubMedCrossRefGoogle Scholar
  23. Crowson MC, Perry M, Burden E (1984) Tuberculosis of the pancreas: a rare cause of obstructive jaundice. Br J Surg 71:239PubMedCrossRefGoogle Scholar
  24. Curran JF, Curran JF (1950) Boeck’s sarcoid of the pancreas. Surgery 28:574–578PubMedGoogle Scholar
  25. de Miguel F, Beltran J, Sabas JA, Sadaba F, Santamaria JM, Bustamante V (1985) Tuberculous pancreatic abscess. Br J Surg 72:438PubMedCrossRefGoogle Scholar
  26. Duncan NA (1948) Pancreatitis due to ascariasis [letter]. Br Med J 1:905PubMedCrossRefGoogle Scholar
  27. Dürr GH-K (1979) Acute pancreatitis. In: Howat HT, Sarles H (eds) The exocrine pancreas. Saunders, London, p 360.Google Scholar
  28. Quoting Schmeider V, Sebening W (1927) Chirurgie des Pankreas. Langenbecks Arch Klin Chir 148:319–387Google Scholar
  29. Evans FC (1969) Pancreatic abscess. Am J Surg 117:537–540PubMedCrossRefGoogle Scholar
  30. Forbus WD, Bestebreurtje AM (1946) Coccidioidomycosis: a study of 95 cases of the disseminated type with special reference to the pathogenesis of the disease. Milit Surg 99:653–719Google Scholar
  31. Freeman R, McMahon MJ (1978) Acute pancreatitis and serological evidence of infection with Mycoplasma pneumoniae. Gut 19: 367–370PubMedCrossRefGoogle Scholar
  32. Friedman HZ, Weinstein RA (1983) Sarcoidosis of the pancreas. Arch Intern Med 143:2182–2183PubMedCrossRefGoogle Scholar
  33. Gallagher P, Chadwick P, Jones DM, Turner L (1981) Acute pancreatitis associated with campylobacter infection. Br J Surg 68:383PubMedCrossRefGoogle Scholar
  34. Goodwin RA, Shapiro JL, Thurman GH, Thurman SS, Des Prez RM (1980) Disseminated histoplasmosis: clinical and pathologic correlations. Medicine 59:1–33PubMedCrossRefGoogle Scholar
  35. Guice KS, Lynch M, Weatherbee L (1987) Invasive aspergillosis: an unusual cause of hemorrhagic pancreatitis. Am J Gastroenterol 82:563–565PubMedGoogle Scholar
  36. Hartley JPR, Douglas AP (1975) A case of clonorchiasis in England. Br Med J iii: 575CrossRefGoogle Scholar
  37. Hawkins SP, Thomas RP, Teasdale C (1987) Acute pancreatitis: a new finding in Cryptosporidium enteritis. Br Med J 294:483–484CrossRefGoogle Scholar
  38. Hearne SE, Whigham TE, Brady CE (1989) Pancreatitis and typhoid fever. Am J Med 86:471–473PubMedCrossRefGoogle Scholar
  39. Hou PC (1955) The pathology of Clonorchis sinensis infestation of the liver. J Pathol Bacteriol 70:53–64PubMedCrossRefGoogle Scholar
  40. Hui AN, Koss MN, Meyer PR (1984) Necropsy findings in acquired immunodeficiency syndrome: a comparison of premortem diagnosis with postmortem findings. Hum Pathol 15:670–676PubMedCrossRefGoogle Scholar
  41. Hurst AF (1934) Syphilis of the pancreas. In: Price FW (ed) A textbook of the practice of medicine, 4th edn. Oxford University Press, London, p 720Google Scholar
  42. Ibrahim EM, Al-Sohaibani MO, Al-Suleiman SA, Sattit MB, Al-Mulhim FA, Qaddura F (1987) Tuberculosis of the pancreas: a rare cause of obstructive jaundice and portal hypertension. Trop Gastroenterol 8:167–172PubMedGoogle Scholar
  43. Imrie CW, Ferguson JC, Sommerville RG (1977) Coxsackie and mumps virus infection in a prospective study of acute pancreatitis. Gut 18:53–56PubMedCrossRefGoogle Scholar
  44. Ishii Y, Koga M, Fugino T et al. (1983) Human infection with the pancreas fluke, Eurytrema pancreaticum. Am J Trop Med Hyg 32:1019–1022PubMedGoogle Scholar
  45. Jenson AB, Rosenberg HS, Notkins AL (1980) Pancreatic islet-cell damage in children with fatal viral infections. Lancet ii: 354–358Google Scholar
  46. Joske RA (1955) Aetiological factors in the pancreatitis syndrome. Br Med J ii: 1477–1481CrossRefGoogle Scholar
  47. Kattan YB (1975) Hydatid cysts in pancreas. Br Med J iv: 729–730CrossRefGoogle Scholar
  48. Khuroo MS, Zargar SA, Mahajan R (1990) Hepatobiliary and pancreatic ascariasis in India. Lancet i: 1503–1506CrossRefGoogle Scholar
  49. Kitai JC, Harid AC, Matenga JA (1987) Tuberculosis of the pancreas mimicking carcinoma: report of a case. Cent Afr J Med 33:19–22PubMedGoogle Scholar
  50. Krige JE, Lewis G, Bornman PC (1987) Recurrent pancreatitis caused by a calcified ascaris in the duct of Wirsung. Am J Gastroenterol 82:256–257 Kune GA, Coster D (1972) Typhoid pancreatic abscess. Med JPubMedGoogle Scholar
  51. Kune GA, Coster D (1972) Typhoid pancreatic abscess. Med J Aust 1:417–418PubMedGoogle Scholar
  52. Lindholt J, Hansen PT (1985) Yersiniosis as a possible cause of acute pancreatitis. Acta Chir Scand 151:703PubMedGoogle Scholar
  53. Longcope WT, Freiman DG (1952) A study of sarcoidosis based on a combined investigation of 160 cases including 30 autopsies from the Johns Hopkins Hospital and Massachusetts General Hospital. Medicine 31:1–132PubMedCrossRefGoogle Scholar
  54. Louw JH, Marks IN, Banks S (1967) The management of severe acute pancreatitis. Postgrad Med J 43:31–44PubMedCrossRefGoogle Scholar
  55. Maher L, Choi H, Dodds WJ (1981) Noncaseating granulomas of the pancreas: probable sarcoidosis. Am J Gastroenterol 75:222–225PubMedGoogle Scholar
  56. McCormick PA, Malone D, Fitzgerald MX, Fitzgerald O (1985) Pancreatitis in sarcoidosis. Br Med J 290:1472–1473CrossRefGoogle Scholar
  57. McCrae WM (1963) Diabetes mellitus following mumps. Lancet i: 1300–1301CrossRefGoogle Scholar
  58. Millar AJW, Rode H, Stunden RJ, Cywes S (1988) Management of pancreatic pseudocysts in children. J Pediatr Surg 23:122–127PubMedCrossRefGoogle Scholar
  59. Mott CB, Neves DP, Okumura M, deBrito T, Bettarello A (1972) Histologic and functional alterations of human exocrine pancreas in Manson’s schistosomiasis. Am J Dig Dis 17:583–590PubMedCrossRefGoogle Scholar
  60. Murphy S, Beeching NJ, Rogerson SJ, Harries AD (1991) Pancreatitis associated with salmonella enteritis [letter]. Lancet 338:571PubMedCrossRefGoogle Scholar
  61. Myhre J, Nesbitt S (1949) Pancreatitis in infectious mononucleosis. J Lab Clin Med 34:1671–1675Google Scholar
  62. Naficy K, Nategh R, Ghadimi H (1973) Mumps pancreatitis without parotitis. Br Med. J i: 529CrossRefGoogle Scholar
  63. Nickerson DA (1937) Boeck’s sarcoid: report of six cases in which autopsies were made. Arch Pathol 24:19–29Google Scholar
  64. Novis JMS (1923) Partial obstruction of the pancreatic duct by round worms. Br J Surg 10:421CrossRefGoogle Scholar
  65. O’Brien PK, Smith DS, Galpin OP (1965) Acute pancreatitis and haemolytic anaemia associated with mumps-virus infection. Br Med J ii: 1529CrossRefGoogle Scholar
  66. Opie EL (1900–1901) On the relation of chronic interstitial pancreatitis to the islets of Langerhans and to diabetes mellitus. J Exp Med 5:397–428CrossRefGoogle Scholar
  67. Papadimitriou J (1987) Pancreatic abscess due to infected hydatid disease. Surgery 102:880–882PubMedGoogle Scholar
  68. Pearce RM (1903) The islets of Langerhans in congenital syphilitic pancreatitis. Am Med 6:1020–1021Google Scholar
  69. Peig M, Ercilla G, Millan M, Gomis R (1981) Post-mumps diabetes mellitus [letter]. Lancet i: 1007CrossRefGoogle Scholar
  70. Pellegrini CA, Paloyan D, Acosta JM, Skinner DB (1977) Acute pancreatitis of rare causation. Surg Gynecol Obstet 144:899–902PubMedGoogle Scholar
  71. Pijls NHJ, Yap SH, Rosenbusch G, Prenen H (1986) Pancreatic mass due to Strongyloides stercoralis infection: an unusual manifestation. Pancreas 1:90–93PubMedCrossRefGoogle Scholar
  72. Pitkänen T, Pönkä A, Pettersson T, Kosunen TU (1983) Campylobacter enteritis in 188 hospitalized patients. Arch Intern Med 143:215–219PubMedCrossRefGoogle Scholar
  73. Poltera AA, Katsimbura N (1974) Granulomatous hepatitis due to Strongyloides stercoralis. J Pathol 113:241–246PubMedCrossRefGoogle Scholar
  74. Raeburn C (1951) Gumma of the pancreas in a premature infant. J Pathol Bacteriol 63:158–159PubMedCrossRefGoogle Scholar
  75. Reichert CM, O’Leary TJ, Levens DL, Simrell CR, Macher AM (1983) Autopsy pathology in the acquired immune deficiency syndrome. Am J Pathol 112:357–382PubMedGoogle Scholar
  76. Renner F, Nimeth C, Demmelbauer N (1991) High frequency of concomitant pancreatitis in salmonella enteritis [letter]. Lancet 337:1611PubMedCrossRefGoogle Scholar
  77. Richter JM, Jacoby GA, Schapiro RH, Warshaw AL (1982) Pancreatic abscess due to Candida albicans. Ann Intern Med 97:221–222PubMedGoogle Scholar
  78. Russell J, Forgacs P, Geraci JE (1976) Pancreatitis complicating typhoid fever: report of a case. JAMA 235:753–754PubMedCrossRefGoogle Scholar
  79. Ryrie DR (1954) Sarcoidosis with obstructive jaundice. Proc R Soc Med 47:879PubMedGoogle Scholar
  80. Sagalow BR, Miller CL, Wechsler RJ (1988) Pancreatic sarcoidosis mimicking pancreatic cancer. J Clin Ultrasound 16:131–134PubMedCrossRefGoogle Scholar
  81. Schlesinger E (1898) Die Erkrankung des Pancreas bei hereditarer Lues. Virchows Archiv 154:501–528CrossRefGoogle Scholar
  82. Shugar RA, Ryan JJ (1975) Clonorchis sinensis and pancreatitis twenty-five years after endemic exposure. Am J Gastroenterol 64:400–403PubMedGoogle Scholar
  83. Simmonds M (1921) Diabetes und Syphilis. Arch Dermat Syph 132:235–237CrossRefGoogle Scholar
  84. Smith MG, Velios F (1950) Inclusion disease or generalised salivary gland virus infection. Arch Pathol 50:862–884Google Scholar
  85. Stambler JB, Klibaner MI, Bliss CM, La Mont JT (1982) Tuberculous abscess of the pancreas. Gastroenterology 83:922–925PubMedGoogle Scholar
  86. Stürmer J, Becker V (1987) Granulomatous pancreatitis — granulomas in chronic pancreatitis. Virchows Arch [A] 410:327–338CrossRefGoogle Scholar
  87. Torre D, Montanari M, Fiori GP, Dietz A, Sampietro C (1987) HIV and the pancreas [letter]. Lancet ii: 1212Google Scholar
  88. Tsou E, Romano MC, Kerwin DM, Soteropoulos GC, Katz S (1980) Sarcoidosis of anterior mediastinal nodes, pancreas, and uterine cervix: three unusual sites in the same patient. Am Rev Respir Dis 122:333–338PubMedGoogle Scholar
  89. Ursing B (1973) Acute pancreatitis in Coxsackie B infection. Br Med J iii: 524–525CrossRefGoogle Scholar
  90. Venderell J, Nubiola A, Goday A et al. (1987) HIV and the pancreas [letter]. Lancet ii: 1212CrossRefGoogle Scholar
  91. Welch K, Finkbeiner W, Alpers CE et al. (1984) Autopsy findings in the acquired immune deficiency syndrome. JAMA 252:1152–1159PubMedCrossRefGoogle Scholar
  92. Wigglesworth JS (1984) Perinatal pathology. Saunders, Philadelphia, p 328Google Scholar
  93. Wilcox CM, Forsmark CE, Grendell JH, Darragh TM, Cello JP (1990) Cytomegalovirus-associated acute pancreatitis disease in patients with acquired immunodeficiency syndrome: report of two patients. Gastroenterology 99:263–267PubMedGoogle Scholar
  94. Wilson S, Thompson AE (1964) A fatal case of strongyloidiasis. J Pathol Bact 87:169–176CrossRefGoogle Scholar
  95. Wislocki LC (1966) Acute pancreatitis in infectious mononucleosis. N Engl J Med 275:322–323PubMedCrossRefGoogle Scholar
  96. Witte CL, Schanzer CB (1968) Pancreatitis due to mumps. JAMA 203:1068–1069PubMedCrossRefGoogle Scholar
  97. Wyatt JP, Saxton J, Lee RS, Pinkerton H (1950) Generalised cytomegalic inclusion disease. J Pediatr 36:271–294PubMedCrossRefGoogle Scholar
  98. Wyatt JP, Hemsath FA, Soash MD (1951) Disseminated cytomegalic inclusion disease in an adult, with primary refractory anemia and transfusional siderosis: report of a case. Am J Clin Pathol 21:50–55PubMedGoogle Scholar
  99. Wyatt JP, Simon T, Trubull ML, Evans M (1953) Cytomegalic inclusion pneumonitis in the adult. Am J Clin Pathol 23:353–362Google Scholar
  100. Zazzo J-F, Pichon F, Regnier B (1987) HIV and the pancreas. Lancet ii: 1212–1213Google Scholar
  101. Zeiderman MR, Wyman A, Euinton HA, Simms JM, Rogers K (1991) Diagnostic difficulties in patients with a pancreatic mass. Br Med J 302:1395–1396CrossRefGoogle Scholar
  102. Zuger A, Wolf BZ, El-Sadr W, Simberkoff MS, Rahal JJ (1986) Pentamidine-associated fatal acute pancreatitis. JAMA 256:2383–2385PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1995

Authors and Affiliations

  • Alan H. Cruickshank
    • 1
  • Emyr W. Benbow
    • 2
  1. 1.The Old HouseLiverpoolUK
  2. 2.Department of PathologyThe Medical School, University of ManchesterManchesterUK

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