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Year : 2001  |  Volume : 19  |  Issue : 2  |  Page : 18-19

Pancreatic abscess caused by s. typhi

Department of Surgery (PKA), Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun - 248140, U.P., India

Correspondence Address:
Department of Surgery (PKA), Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun - 248140, U.P., India

 ~ Abstract 

A case of pancreatic abscess due to Salmonella typhi in a 40-year-old male is presented. The patient was managed by percutaneous needle aspiration and antibiotic therapy.

How to cite this article:
Arya M, Arya P K. Pancreatic abscess caused by s. typhi. Indian J Med Microbiol 2001;19:18-9

How to cite this URL:
Arya M, Arya P K. Pancreatic abscess caused by s. typhi. Indian J Med Microbiol [serial online] 2001 [cited 2020 May 30];19:18-9. Available from:

Bacteremia is a constant feature of enteric fever and can occur as a rare complication of any  Salmonella More Details infection . Occasionally dissemination of bacilli throughout the body results in establishment of one or more localized foci of persisting infection especially where pre-existing abnormality makes a tissue or organ vulnerable[1].
We report here a case of pancreatic abscess from which  Salmonella More Details typhi was isolated.

 ~ Case Report Top

A 40-year-old male presented with history of fever, jaundice and pain in upper abdomen for 4 days. Patient was an alcoholic for last 20 years. There was no previous history of typhoid fever. On examination, patient was febrile and had severe jaundice. On abdominal examination, there was tenderness in upper abdomen. An epigastric mass was felt which was retroperitoneal . Patient was given Inj. Amikacin , Metronidazole and Cefotaxime .The white blood cell count was 11,400/cu mm with 78% polymorphs. Serum bilirubin was 31mg/dL . Ultrasound and magnetic resonance imaging revealed a cystic mass in the head of pancreas. Jaundice was because of pancreatic cystic mass compressing the common bile duct. Ultrasound guided percutaneous needle aspiration yielded 100 mL pus. The pus was sent for bacterial culture and sensitivity.
Non lactose-fermenting colonies were isolated, which on the basis of gram staining, motility, biochemical reactions and agglutination with specific antisera was identified as  Salmonella More Details typhi . The isolate was sensitive to Chloramphenicol, Ampicillin, Co-trimoxazole, Ciprofloxacin and Ceftriaxone. Blood culture showed no growth but, Widal test revealed titres of 320 for both  Salmonella More Details typhi O and H antigens. Patient was given Ciprofloxacin 200 mg twice a day intravenously for 2 weeks with rapid clinical improvement . No further aspiration was done.
Repeat ultrasound on third post aspiration day did not show any abscess. Serum bilirubin was 8.6 mg/dL on the same day and it was 1.5 mg/dL on 8th post aspiration day. Repeat Widal test after 2 weeks revealed titres of O=80 and H 320.

 ~ Discussion Top

Local abscess formation may occur as a complication of any  Salmonella More Details infection. Pathogenesis of pancreatic abscess is not well established . Possible pathways may be infective bile reaching pancreas by pancreatic duct (bile reflux theory), haematogenous spread from distant site or lymphatic spread from intestinal tract[2].
There are few published reports of localized involvement of pancreas by  Salmonella More Details typhi. Garg and Parasher[3] reported a case of pancreatic abscess due to  Salmonella More Details typhi. Another case was reported by Kune and Coster[4]. In patients with typhoid fever Koshi[5] reported two cases of chronic pancreatitis, while 4 cases of pancreatitis were reported by Hermans et al.[6]
 Salmonella More Details usually localizes in tissues or organs with pre-existing abnormality, as mentioned earlier. In the present case , the patient was a chronic alcoholic with probable pre-existent damage to the pancreas making it easier for  Salmonella More Details typhi to localize.
Percutaneous ultrasound guided aspiration for pancreatic abscess is an accepted procedure now, as surgical drainage carries very high risk[7]

 ~ References Top

1.Greenwood, Slack, Peutherer. Medical Microbiology: 15th ed. Churchill Livingstone 1997.  Back to cited text no. 1    
2.Strand CL, Sander CL. Salmonella typhimurium pancreatic abscess - a report of a case. Am Surg 1978; 44:174 - 176.  Back to cited text no. 2    
3.Garg P, Parashar S. Pancreatic abscess due to Salmonella typhi . Postgrad Med J 1992; 68:294-295.  Back to cited text no. 3    
4.Kune GA, Coster D. Typhoid pancreatic abscess. Med J Aust 1972; 1:417-418.  Back to cited text no. 4    
5.Koshi G. Uncommon manifestations of Salmonella infections . Ind J Med Res 1976; 64:314-321.  Back to cited text no. 5    
6.Hermans P, Gerard M, Van Laethem Y, Dewit S, Clumeck N. Pancreatic disturbances and Typhoid fever . Scan J Inf Dis 1991; 23:201-205.  Back to cited text no. 6    
7.Sabiston DC, Lyerly HK. Textbook of Surgery -The Biological Basis of Modern Surgical Practice: 15th ed. W.B. Saunders 1997.  Back to cited text no. 7    
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2004 - Indian Journal of Medical Microbiology
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