A blocked or obstructed pancreas can cause severe abdominal pain and other symptoms. The pancreas is an important organ that produces enzymes to help digest food and hormones like insulin to regulate blood sugar. When the pancreatic duct becomes blocked, these enzymes and fluids can build up in the pancreas, causing inflammation, swelling, and damage to the tissues.
What causes a blocked pancreas?
There are several potential causes of pancreatic duct obstruction:
- Gallstones – Gallstones are one of the most common causes. A stone may pass from the gallbladder into the bile duct, get stuck at the opening where the bile duct and pancreatic duct meet, and block pancreatic fluid outflow.
- Pancreatic tumors – Tumors in the pancreas, especially in the head of the pancreas, can compress and block the pancreatic duct.
- Pancreatitis – Chronic pancreatitis causes inflammation and scarring that can narrow or block the pancreatic duct.
- Pancreatic pseudocysts – Fluid collections or cysts related to pancreatitis can put pressure on and obstruct the pancreatic duct.
- Oddi sphincter dysfunction – The sphincter of Oddi is a muscular valve where the pancreatic duct joins the common bile duct. Spasms or scarring can cause it to become stuck closed.
- Trauma – Direct trauma to the pancreas from an accident, injury, or surgery could potentially damage the pancreatic duct.
- Congenital abnormality – Some people are born with an anatomically abnormal or blocked pancreatic duct.
What are the symptoms of a blocked pancreas?
The most common symptoms of a blocked or obstructed pancreatic duct are:
- Severe upper abdominal pain – This is usually a steady, boring, unrelenting pain in the upper middle abdomen that often radiates to the back. It may be felt below the ribs and can last for hours or days if untreated.
- Nausea and vomiting – The pain is often so severe that it causes nausea and vomiting.
- Fever – Some people develop a low-grade fever due to pancreatic inflammation.
- Jaundice – If the bile duct is also blocked by whatever is obstructing the pancreatic duct, it can lead to yellowing of the skin and eyes from bile buildup.
- Greasy stools – Stools may contain excess fat due to the inability to properly digest food.
- Unintended weight loss – Severe abdominal pain and poor digestion can lead to weight loss.
The pain is often the most prominent feature. It is typically a constant, penetrating, “boring” type of pain that just won’t go away. It may be felt in the upper middle abdomen just below the ribs, and can radiate all the way through to the back.
What does the pain from a blocked pancreas feel like?
People often describe the pain from a blocked pancreas as:
- Severe
- Constant
- Piercing
- Intense
- Dull
- Aching
- Cramping
- “Boring” into the abdomen
The pain may start suddenly or develop gradually over hours to days. It typically feels worse after eating or drinking, particularly fatty or greasy foods. The pain can be localized to the upper abdomen or it may radiate to the middle or left upper back. People often have great difficulty finding a comfortable position.
How is a blocked pancreas diagnosed?
If a blocked pancreas is suspected based on symptoms, especially severe unrelenting abdominal pain, the doctor will order imaging tests to confirm the diagnosis and find the cause. Tests may include:
- Abdominal CT scan – This is usually the first test ordered and can detect stones, tumors, cysts, inflammation, and other abnormalities blocking the pancreatic duct.
- MRCP – A magnetic resonance cholangiopancreatography (MRCP) uses MRI technology to visualize the pancreatic and bile ducts. It can be used if a CT is inconclusive.
- Endoscopic ultrasound – An endoscope with an ultrasound probe on the end can be passed down the throat into the stomach and duodenum to obtain detailed ultrasound images of the pancreas.
- ERCP – During endoscopic retrograde cholangiopancreatography (ERCP), a scope is passed into the duodenum and a catheter is used to inject contrast dye into the ducts. X-rays are then taken to highlight blockages.
Blood tests such as amylase and lipase may be elevated due to pancreatic inflammation but are not specific for duct obstruction. The imaging tests allow visualization of the pancreatic duct to confirm a blockage and what is causing it.
What is the treatment for a blocked pancreas?
Treatment of a blocked pancreas depends on the cause but may involve:
- Pain management – Strong pain medications like morphine are often needed in the short-term to control severe pain.
- Fluids and nutrition – Fluids and nutritional support are important, especially if nausea and vomiting are present. Feedings may need to be given through an IV or feeding tube.
- Endoscopy – If gallstones are blocking the duct, they may be removed with ERCP. Stents can also be placed endoscopically to open up strictures.
- Surgery – Those who do not improve with endoscopy may need surgical removal of gallstones obstructing the pancreatic duct or a bypass procedure for other types of obstructions.
Quick drainage of pancreatic secretions is important to resolve symptoms and prevent permanent pancreatic damage. IV fluids and pain medications are used to stabilize patients in the short term while definitive treatment is planned depending on the cause of the obstruction.
Are there any complications from a blocked pancreas?
Potential complications of a blocked pancreatic duct include:
- Acute pancreatitis – If enzymes back up and damage the pancreas, it can cause inflammation and swelling (pancreatitis). This may become a chronic problem.
- Infection – Bacteria can sometimes ascend into the blocked pancreatic duct and cause pancreatic or peripancreatic abscesses.
- Malnutrition – Severe pain, nausea, and poor digestion can lead to nutritional deficiencies and unintended weight loss.
- Diabetes – Extensive damage to the insulin-producing beta cells of the pancreas could cause diabetes.
- Pseudocysts – Collections of pancreatic fluid outside the pancreas may form cysts or abscesses.
- Pancreatic cancer – Those with chronic pancreatic duct obstruction have an increased risk of pancreatic cancer.
That is why prompt evaluation and treatment of pancreatic duct obstruction is important – to relieve symptoms and prevent permanent pancreatic damage or other complications.
What are the long term consequences of a blocked pancreas?
Potential long term consequences of a blocked pancreatic duct include:
- Chronic pancreatitis – Repeated bouts of inflammation can permanently damage the pancreas leading to chronic pancreatitis.
- Exocrine pancreatic insufficiency – Damage to cells that produce digestive enzymes may impair food digestion over the long-term.
- Endocrine insufficiency – Damage to insulin-producing beta cells may eventually lead to diabetes.
- Increased cancer risk – Those with chronic pancreatic duct obstruction seem to be at higher risk of pancreatic cancer.
- Pain syndromes – Chronic pancreatic or abdominal pain sometimes occurs and can be difficult to treat.
- Maldigestion – Poor absorption of fats and nutrients can lead to vitamin deficiencies.
- Weight loss – Significant weight loss or malnutrition may occur if digestion remains impaired.
Prompt and appropriate treatment is important to avoid permanent damage that can impair both exocrine and endocrine functions of the pancreas. Follow up care is needed to monitor for and manage any long-term consequences if they arise.
When to see a doctor
It is important to seek prompt medical attention if you experience:
- Severe or worsening abdominal pain, especially if it radiates to the back
- Persistent nausea and vomiting
- Fever, chills, or unintentional weight loss
- Yellowing of the skin or eyes
- Light colored or greasy stools
These symptoms could indicate a blocked pancreas or other medical emergency requiring further evaluation. Sudden, severe abdominal pain that causes you to double over or takes your breath away is a red flag that should not be ignored. Call your doctor right away or go to the emergency room if you have these types of symptoms for evaluation and treatment.
Key Points
- A blocked pancreas occurs when the pancreatic duct becomes obstructed, often by gallstones, tumors, scarring from pancreatitis, or other issues.
- It causes severe steady abdominal pain, nausea, vomiting, and sometimes fever or jaundice.
- Diagnostic tests like CT, MRI, or ERCP are needed to confirm the obstruction.
- Treatment involves pain control, IV fluids, endoscopic or surgical relief of the obstruction.
- Complications like pancreatitis, infection, diabetes, and pancreatic cancer can occur.
- Seek medical care promptly for severe unexplained abdominal pain to prevent permanent damage.
Conclusion
A blocked pancreas is a serious medical condition requiring prompt evaluation and treatment. The typical symptoms are severe unrelenting upper abdominal pain often radiating to the back, nausea, vomiting, and sometimes fever or jaundice. It is considered a medical emergency because the backup of pancreatic enzymes can damage the pancreas and lead to serious short and long-term consequences. If you develop these types of symptoms, do not wait to see if they resolve on their own. Seek medical attention as soon as possible for proper diagnosis and management of this condition.