PERCUTANEOUS ASPIRATION FOR BACTERIOLOGICAL STUDIES IN PATIENTS WITH NECROTIZING PANCREATITIS

Background Percutaneous computed tomography (CT)-guided aspiration of abdominal collections is performed in necrotizing pancreatitis to dete ct infection of necrosis, which is an adverse prognostic factor and re quires surgical drainage. However, in the case of sterile aspirates, t he outcome and the optimum management are subject to debate. This stud y examined the clinical and bacteriological outcome of patients with s evere acute pancreatitis with initially sterile necrosis and assessed the efficiency of percutaneous drainage in this setting.Methods Sevent een patients hospitalized for necrotizing pancreatitis with a septic c ourse underwent a preliminary sterile CT-guided aspiration. Eight pati ents underwent simultaneous percutaneous drainage of the punctured col lection. Supportive therapy was continued unless severe clinical deter ioration or proven secondary infection of necrosis indicated the need for necrosectomy and drainage. Results Secondary infection of necrosis was observed in two patients of nine who had only fine-needle aspirat ion cytology of the collection, and in seven of eight it was drained p ercutaneously (P = 0.01). Only one patient drained percutaneously reco vered without surgery. Surgical drainage was required in 12 patients. The hospital mortality rate was 29 per cent and was not significantly affected by the bacteriological status of necrosis. Conclusion Percuta neous drainage of sterile collections predisposed to secondary infecti on of the necrosis and did not cure the patients. A first sterile perc utaneous aspiration did not predict a favourable course and surgery fr equently remains necessary.