INTERVENTIONAL AND SURGICAL-TREATMENT OF PANCREATIC-ABSCESS

Pancreatic abscess is one of the infectious complications of acute pan creatitis. It is a collection principally containing pus, but it may a lso contain variable amounts of semisolid necrotic debris. Most of the se abscesses evolve from the progressive liquefaction of necrotic panc reatic and peripancreatic tissues, but some arise from infection of pe ripancreatic fluid or collections elsewhere in the peritoneal cavity. Included also are abscesses found after surgical debridement and drain age of pancreatic necrosis. Although open surgical treatment of infect ed necrosis is the established treatment of choice, percutaneous drain age of abscesses is successful in some circumstances. We used percutan eous catheter drainage in 39 patients during 1987-1995. Only 9 of 29 ( 31%) attempts at primary therapy sere successful; 2 patients died, and 18 required subsequent surgical drainage. On the other hand, 14 of 14 patients with recurrent or residual abscesses after surgical drainage were successfully drained percutaneously. Percutaneous catheter drain age of pancreatic abscesses may be useful for initial stabilization of septic patients, drainage of further abscesses after surgical interve ntion (especially when access for reoperation will be difficult), asso ciated abscesses remote from the pancreas, and selected unilocular col lections at a sufficient interval after necrotizing pancreatitis to ha ve allowed essentially complete liquefaction.