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Fatal septic shock after fine needle aspiration of a pancreatic pseudocyst
Abstract:
Fatal septic shock due to Streptococcus sanguis developed eight days after fine needle aspiration (FNA) of a pancreatic pseudocyst. The pseudocyst was adherent to the transverse colon (as is often the case with pseudocysts), and contamination of cyst fluid with colonic bacteria most likely initiated the infection. The patient had not received prophylactic antibiotics, even though the needle had been observed to pass through the bowel at the time of the CAT-scan-guided aspiration. Although the literature documents the safety and usefulness of FNA in the diagnosis of pancreatic tumors, this case suggests that prophylactic antibiotics be considered at the time of aspiration of pseudocysts or necrotic tumors.
Insights
A rare case of fatal septic shock after pancreatic pseudocyst aspiration highlights infection risks. This suggests considering prophylactic antibiotics during procedures involving potential bowel contamination.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Oncology
Background:
- Fine needle aspiration (FNA) is a common diagnostic tool for pancreatic masses.
- Pancreatic pseudocysts can adhere to surrounding structures, including the colon.
- Infection is a potential complication of invasive procedures.
Observation:
- A patient developed fatal septic shock caused by Streptococcus sanguis eight days post-FNA of a pancreatic pseudocyst.
- The pseudocyst was adhered to the transverse colon, suggesting bacterial contamination during aspiration.
- Prophylactic antibiotics were not administered despite the needle passing through the bowel.
Findings:
- Contamination of pancreatic pseudocyst fluid with colonic bacteria likely led to the Streptococcus sanguis infection.
- The case underscores a potential risk associated with FNA in cases of bowel adherence.
Implications:
- This case suggests that prophylactic antibiotics should be considered for FNA of pancreatic pseudocysts or necrotic tumors, especially when bowel contamination is possible.
- Enhanced vigilance and preventative measures may be necessary to mitigate infection risks during pancreatic FNA procedures.