PERCUTANEOUS CT-GUIDED CATHETER DRAINAGE OF INFECTED ACUTE NECROTIZING PANCREATITIS - TECHNIQUES AND RESULTS

OBJECTIVE. The objective of this paper was to assess the safety and ef ficacy of percutaneous catheter drainage for initial treatment of infe cted acute necrotizing pancreatitis, MATERIALS AND METHODS. Thirty-fou r patients with acute necrotizing pancreatitis shown with contrast-enh anced CT were treated for sepsis with percutaneous catheter drainage. Extent of necrosis was less than 30% in 10 cases, 30-50% in 10 cases, and greater than 50% in 14 cases. Fourteen patients had central necros is, Eighteen patients were critically ill with multiorgan failure. RES ULTS. Sixteen (47%) of the 34 patients were cured with only percutaneo us catheter drainage, including four (29%) of the 14 patients with cen tral gland necrosis and 12 (60%) of the 20 with body-tail necrosis, Se psis was controlled (defervescence of fever and return of WBC to norma l) in an additional nine patients, allowing elective pancreatic surger y for control of pancreatic duct fistula. Eight patients failed to sho w clinical improvement after drainage and required necrosectomy. No pa tient experienced catheter-related complications, Mortality was 12% (a ll four deaths occurred after necrosectomy because of multiorgan failu re), CONCLUSION. Percutaneous catheter drainage is a safe and effectiv e technique for treating infected acute necrotizing pancreatitis, Over all, sepsis was controlled in 74% of patients, permitting elective sur gery for treatment of pancreatic fistula, and 47% of patients were cur ed with no surgery required, No catheter-related complications occurre d.