Internal drainage of infected pancreatic pseudocysts: Safe or sorry?

Background: External drainage is the traditional surgical therapy for infec ted pancreatic pseudocyst, although associated with high morbidity and mort ality rates. In this study it was determined whether internal drainage is f easible with acceptable postoperative morbidity and recurrence rates. Metho ds: A retrospective comparison was made of the outcome of internal versus e xternal drainage of infected pseudocysts in 15 patients. All patients were known to have a (sterile) pseudocyst and presented with symptoms suggestive of infection of the cyst, proven by positive cultures and Gram staining. R esults: Internal drainage was performed in 8 and external drainage in 7 pat ients. Patient characteristics appeared comparable, as was the time of ster ile cyst presence before infection occurred (6 and 9 weeks, respectively). No major complications occurred, although hospital stay was prolonged after external drainage due to development of pancreaticocutaneous fistulas alon g the drain tract in 4 patients. Enteric microorganisms were cultured in 11 patients, of whom 10 had undergone ERCP just prior to infection. During fo llow-up no pseudocyst recurred. Conclusion: Surgical internal drainage of a n infected pseudocyst is safe and effective and, in selected patients, is f irst-choice treatment. ERCP seems to play an important role in the secondar y infection of pseudocysts, Copyright (C) 1999 S. Karger AG, Basel.