Pancreatic abscess: analysis of a high risk subgroup

Over the past ten years, 21 cases of pancreatic abscess were diagnosed at our university teaching hospital. On the basis of the findings from CT scan, sonography, and exploratory laparotomy, five patients were determined to have poorly localized disease and 16 patients were felt to have well localized purulent fluid collection. The five patients with poorly localized disease had an overall mortality rate of 80%, an average of 5.2 Ranson criteria, and 80% required partial pancreatic resection. Of the 16 patients with well localized disease there was a mortality rate of 20%, an average of 3.3 Ranson criteria, and only 6% required resection. All five patients who had pancreatic resection died. These data suggest the following conclusions: 1. Patients with pancreatic abscess which is poorly localized have a greater severity of pancreatitis as indicated by a higher average number of Ranson criteria. 2. Patients with a poorly localized phlegmonous abscess more often require pancreatic resection, which is associated with a higher mortality. 3. The high mortality rate seen with patients with a poorly localized phlegmonous pancreatic slough designates this group as a high risk subset of all pancreatic abscess patients.