PERCUTANEOUS RADIOLOGIC DRAINAGE OF PANCREATIC ABSCESSES

OBJECTIVE. The purpose of our study was to review and report the patie nt selection, techniques and results of percutaneous drainage of pancr eatic abscesses by retrospective review. MATERIALS AND METHODS. Fifty- nine patients (46 men and 13 women) with a mean age of 44 years old ha d 80 pancreatic abscesses that were drained percutaneously under radio logic guidance (CT, n = 77; sonography, n = 2; and fluoroscopy, n = 1) . Abscesses had a wide spectrum of causes, with alcoholic pancreatitis being most common, trauma second most common, and gallstones third, T en patients had undergone surgery for pancreatic necrosis or abscess, Patients with pancreatic pseudocysts, necrosis, or acute fluid collect ions were excluded from this study. RESULTS. Of the 59 patients, 51 (8 6%) were cured with percutaneous drainage and antibiotic therapy. Of t he patients who were not cured with percutaneous drainage, seven requi red surgery and one underwent repeat percutaneous drainage, In the 59 patients, complications included non-life-threatening bleeding in thre e patients. Ten of 59 patients (17%) had fistulas that spontaneously f ormed into the gastrointestinal tract. The duration of catheterization ranged from 4 to 119 days, with a mean duration of 33 days. The rate of mortality at 30 days after completion of percutaneous drainage was 8% (5 of 59). CONCLUSION. Percutaneous drainage was an effective thera py for this defined group of patients with pancreatic abscesses. Facto rs lending to the relatively high success rate described in this study likely included selection of patients; catheters of adequate size, nu mber, and location; careful follow-up with appropriate catheter manipu lations; and an integrated, cooperative approach whereby surgeons were willing to permit drainage to effect its benefits, rather than operat ing prematurely.