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Pancreatic phlegmon: what is it?

S T Fan1, T K Choi, F L Chan

  • 1Department of Surgery, University of Hong Kong.

American Journal of Surgery
|June 1, 1989
PubMed
Summary

Acute pancreatitis patients with phlegmon, identified via imaging and clinical signs, often experience prolonged symptoms but generally have a benign condition. Surgery is typically not recommended for this specific presentation.

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Area of Science:

  • Gastroenterology
  • Radiology
  • Internal Medicine

Background:

  • Acute pancreatitis is a common gastrointestinal emergency.
  • Phlegmon is a recognized complication of acute pancreatitis, characterized by inflammation and fluid collection.
  • Distinguishing phlegmon from other pancreatitis complications is crucial for appropriate management.

Purpose of the Study:

  • To identify patients with acute pancreatitis who developed phlegmon.
  • To define the radiologic and clinical characteristics of phlegmon in acute pancreatitis.
  • To evaluate the clinical course and outcomes of patients with phlegmon.

Main Methods:

  • Retrospective study of 264 patients with acute pancreatitis.
  • Identification of phlegmon using combined computed tomography (CT) scan findings and clinical criteria (absence of sepsis).
  • Radiologic criteria included abnormal CT lesions with mixed density, no extraluminal gas, and lack of a well-defined wall.

Main Results:

  • Twenty-two patients (8.3%) were identified with phlegmon.
  • Half of these patients had severe pancreatitis based on prognostic signs.
  • Symptoms like fever, leukocytosis, and elevated amylase persisted longer, but complications were infrequent.
  • Lesions could remain asymptomatic for 3-4 months.

Conclusions:

  • Phlegmon in acute pancreatitis, as defined by specific radiologic and clinical criteria, appears to be a relatively benign condition.
  • The findings suggest that surgical intervention should be avoided in such cases.
  • Further research may be warranted to confirm the long-term outcomes and optimal management strategies.

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