ANATOMIC ACCESS TO PANCREATIC FLUID COLLECTIONS

In approximately 10% of patients, acute pancreatitis is complicated by formation of acute fluid collections, necrosis, abscess, or pseudocys ts.(1) These changes may remain confined to the pancreas or may extend to the lesser sac, the pararenal spaces, the root of the small bowel mesentery, or the transverse mesocolon. Occasionally, inflammatory cha nges and fluid collections involve more distant sites such as the medi astinum, the pelvis, or subcapsular collections in the spleen or liver . Radiographic imaging by ultrasonography and contrast-enhanced comput ed tomography has proven to be valuable for detection of complications of acute pancreatitis.(2) Imaging has a significant impact on patient management and facilitates the choice between conservative treatment vs surgical or percutaneous radiological intervention.(3-7) Large simp le fluid collections such as chronic pseudocysts are often readily acc essible to percutaneous drainage. More commonly, however, patients pre sent with complex, multiloculated fluid collections.(8) Attempts at pe rcutaneous drainage frequently present a technical challenge and requi re careful planning of a safe access route. The purpose of this articl e is to illustrate a variety of potential access routes and to discuss their advantages and disadvantages based on our experience with percu taneous drainage procedures in patients with complicated pancreatitis.