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Does an infected peripancreatic fluid collection or abscess mandate operation?
N B Baril1, P W Ralls, S M Wren
1Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Annals of Surgery
|March 14, 2000
Summary
Percutaneous catheter drainage (PCD) is an effective initial treatment for infected pancreatic fluid collections. This approach should be considered before surgery, reserving operative intervention for cases where PCD fails.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Surgical Oncology
Background:
- Historically, surgical intervention was the primary treatment for infected peripancreatic fluid collections and abscesses.
- Percutaneous catheter drainage (PCD) has emerged as an alternative, but reported outcomes are varied.
- This study evaluates the efficacy of PCD in managing these complex conditions.
Purpose of the Study:
- To assess the effectiveness of percutaneous catheter drainage (PCD) in treating peripancreatic fluid collections and abscesses.
- To compare PCD outcomes with traditional surgical interventions.
- To determine the role of PCD as a primary therapy.
Main Methods:
- Retrospective chart review of 82 patients treated between 1993 and 1997.
- Inclusion criteria: computed tomography-guided aspiration for suspected infected pancreatic fluid collection or abscess.
- Data assessed: culture results, need for surgery, length of stay, and mortality rates.
Main Results:
- 82 patients underwent 135 aspirations; common etiologies included alcohol and gallstones.
- Cultures were positive in 42 patients; 25 of these received PCD as primary therapy, with 6 requiring subsequent surgery.
- Mortality rates were 12% for culture-positive patients and 8% overall.
Conclusions:
- Percutaneous catheter drainage (PCD) represents an evolving strategy for managing infected peripancreatic fluid collections.
- PCD should be considered the initial treatment for culture-positive patients.
- Surgical intervention should be reserved for cases where PCD proves unsuccessful.
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