Does an infected peripancreatic fluid collection or abscess mandate operation?

Objective To assess the treatment of peripancreatic fluid collections or abscess with percutaneous catheter drainage (PCD). Summary Background Data Surgical intervention has been the mainstay of treatment for infected perip ancreatic fluid collections and abscesses. Increasingly, PCD has been used, with mixed results reported in the literature. Methods A retrospective chart review of 1993 to 1997 was performed on 82 patients a t a tertiary care public teaching hospital who had computed tomography-guid ed aspiration for suspected infected pancreatic fluid collection or abscess . Culture results, need for subsequent surgical intervention, length of sta y, and death rate were assessed, Results One hundred thirty-five aspirations were performed in 82 patients (57 male patients. 25 female patients) with a mean age of 40 years (range 17-68). Th e etiologies were alcohol (41), gallstones (32), and other (9). The mean nu mber of Ranson's criteria was four (range 0-9). All patients received antib iotics. Forty-eight patients had evidence of pancreatic necrosis on compute d tomography scan. Cultures were negative in 40 patients and positive in 42 . Twenty-five of the 42 culture-positive patients had PCD as primary therap y. and 6 required subsequent surgery. Eleven patients had primacy surgical therapy, and five required subsequent surgery. Six patients were treated wi th only antibiotics. The death rates were 12% for culture-positive patients and 8% for the entire 82 patients. Conclusions Historically, patients with positive peripancreatic aspirate culture have r equired operation. This series reports an evolving strategy of reliance on catheter drainage. PCD should be considered as the initial therapy for cult ure-positive patients, with surgical intervention reserved for patients in whom treatment fails.