Interventional and surgical treatment of pancreatic abscess

Mithöfer, Kai; Müeller, Peter R.; Warshaw, Andrew L.

doi:10.1007/s002689900209

Cited by 96 publications

(52 citation statements)

References 55 publications

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“…Similarly, the Massachusetts General Hospital researchers 33 recently concluded that PCD was beneficial for the initial stabilization of septic patients or for patients with postsurgical abscesses; the overall success rate was only 31%, but it was 100% in patients with recurrent or residual abscesses. Adams et al 36 reported a 79% success rate of PCD for infected pancreatic and peripancreatic fluid collections, with a death rate of 14%.…”

Section: Discussionmentioning

confidence: 99%

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

et al. 2000

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ObjectiveTo assess the treatment of peripancreatic fluid collections or abscess with percutaneous catheter drainage (PCD). Summary Background DataSurgical intervention has been the mainstay of treatment for infected peripancreatic fluid collections and abscesses. Increasingly, PCD has been used, with mixed results reported in the literature. MethodsA retrospective chart review of 1993 to 1997 was performed on 82 patients at a tertiary care public teaching hospital who had computed tomography-guided aspiration for suspected infected pancreatic fluid collection or abscess. Culture results, need for subsequent surgical intervention, length of stay, and death rate were assessed. ResultsOne 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). The etiologies were alcohol (41), gallstones (32), and other (9). The mean number of Ranson's criteria was four (range 0 -9). All patients received antibiotics. Forty-eight patients had evidence of pancreatic necrosis on computed tomography scan. Cultures were negative in 40 patients and positive in 42. Twenty-five of the 42 culture-positive patients had PCD as primary therapy, and 6 required subsequent surgery. Eleven patients had primary surgical therapy, and five required subsequent surgery. Six patients were treated with only antibiotics. The death rates were 12% for culture-positive patients and 8% for the entire 82 patients. ConclusionsHistorically, patients with positive peripancreatic aspirate culture have required operation. This series reports an evolving strategy of reliance on catheter drainage. PCD should be considered as the initial therapy for culture-positive patients, with surgical intervention reserved for patients in whom treatment fails.Historically, the presence of an infected peripancreatic fluid collection or pancreatic abscess has mandated operation. Primary surgical treatment is successful for most patients, but the death rate is reportedly 15% to 80%, and surgery is associated with reoperation and prolonged lengths of stay.1 It has been more than 20 years since the treatment of pancreatic abscess was reviewed at our institution.2 In that report, Holden et al identified a death rate of 50% among 28 patients treated operatively and a complication rate of 93%.The availability of percutaneous catheter drainage (PCD) under radiologic guidance has replaced surgical drainage as the primary treatment of intraabdominal and hepatic abscesses. 3 A natural progression of the use of PCD has been its application for peripancreatic fluid collections and abscess. To ascertain the relative merits of PCD and to guide patient selection, we performed a retrospective chart review of patients with peripancreatic fluid collections or pancreatic abscess who had computed tomography (CT)-guided aspiration.

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Section: Discussionmentioning

confidence: 99%

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

et al. 2000

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“…It does not contain a considerable quantity of necrotic tissue mass in opposition to the infected liquified necrosis (Post-necrotic Pancreatic Fluid Collection, Walled-off Pancreatic Necrosis). On CT scan gas bubbles can be observed [1, 2,5,6,18,20,29,37,43]. Surgery in these cases involves a lower rate of morbidity and mortality than those performed in the early phase of pancreatitis.…”

Section: Acute Pseudocystmentioning

confidence: 95%

“…The results are good [20,37]. Percutaneous drainage treatment can be applied in cases of pancreatic abscess with good results and it can be suggested as the first intervention [4,5,6,8,18,20,29,33,37,38,43]. Drainage can be also applied in cases of numerous abscesses.…”

Section: Acute Pseudocystmentioning

confidence: 99%

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The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

Szentkereszty¹,

Kotán²,

Sápy³

2012

Acute Pancreatitis

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What to drain? Acute peripancreatic fluid collection (APFC)According to the Atlanta Classification peripancreatic fluid collection develops in the early phase of acute pancreatitis in about 40% of cases. The acute fluid collection usually develops around the pancreas but sometimes emerges in the glandular area and does not contain a high quantity of necrosis. Not rarely, it spreads into the chest, mediastinum and/or into the pararenal area. Several fluid collections can develop at the same time and can shuttle together. The rich pancreatic enzyme content of the fluid can indicate communication with the pancreatic duct or indicate parenchymal necrosis. They do not have definite walls, and are limited by the walls of the surrounding organs. In a significant number of cases (about 30-50%), spontaneous resolution occurs without surgical or other intervention. If they do not show tendency towards resolution, they can become of significant size and cause clinical symptoms or complications [5,6,33,44]. The most frequent complaints caused by a big, 8-15 cm size acute fluid collection are pain, tension, and increasing abdominal pressure which can significantly worsen the efficiency of breathing [1,9]. In other cases they can cause compression symptoms (jaundice, duodenal obstruction) or bleeding can develop inside of them. Another frequent complication is the

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“…Some recent reports advocate the use of imaging guided techniques for patients with a variety of complications of acute pancreatitis with promising results (52,53,54,89,90). Pseudocysts result most commonly from an attack of pancreatitis associated with disruption of the pancreatic duct.…”

Section: Protease Inhibitorsmentioning

confidence: 99%