Acute complicated pancreatitis: redefining the role of interventional radiology

Computed tomographic (CT) scans in 30 patients who had undergone percutaneous drainage for acute complicated pancreatitis were retrospectively studied to determine the role of percutaneous drainage. Fifty-nine collections were percutaneously drained in these 30 patients. Eighty-one catheters were placed in the 59 collections (average, 1.4 catheters per patient). Patients required an average of three catheter manipulations, seven abdominal CT scans, 5 weeks of catheter drainage, a mean hospital stay of 82 days (range, 42-122 days), and a mean intensive care unit stay of 31 days (range, 1-62 days). Percutaneous intervention was successful in 14 patients, partially successful in four, and unsuccessful in eight. A temporizing effect was seen in four patients. Percutaneous intervention was successful in one of 10 central (pancreas and lesser sac areas) collections and 28 of 49 peripheral collections. Surgical debridement was necessary in 16 patients because of failed or incomplete percutaneous drainage. Complications occurred in five patients, and the mortality rate was 33%. Drainage of central areas should initially be performed by a surgeon, while peripheral collections should be drained percutaneously as they develop.