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[Pancreatic abscess. Extraperitoneal drainage]
Abstract:
The pancreatic abscess occurs in two to six per cent of patients with acute pancreatitis and in 40 to 50 per cent of whom develop the severe form of the disease. The postoperative morbidity rate is 85 to 90 per cent and the mortality rate is 30 to 50 per cent due to persistence or recurrence of infection. The anatomical location and dissemination of the pancreatic abscess allows an extraperitoneal approach. Twelve patients with pancreatic abscess are reported. Seven males and five females, with an average age of 36 years. Fever, abdominal pain, cutaneous hypersensitivity and palpable abdominal mass were the most frequent clinical signs. Most of them developed multiple organic failure, leukocytosis, hyperglycemia, increasing L.D.H. and alkaline phosphatase levels. The CAT scan was most useful to localize the abscess. About 83 per cent of patients had been operated on previously. The extraperitoneal surgical approach was anterior in 10 patients and posterior in two patients. Ten patients developed complications that resolved with conservative measures. Two patients (17%) died. Extraperitoneal drainage is a valid alternative to prevent peritoneal contamination and some other serious postoperative complications in the management of pancreatic abscess.
Insights
Extraperitoneal drainage effectively manages pancreatic abscesses, a complication of acute pancreatitis. This approach reduces severe complications and mortality, offering a safer alternative for patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Infectious Diseases
Context:
- Pancreatic abscesses complicate acute pancreatitis, particularly severe forms, with high morbidity and mortality.
- These abscesses often require intervention due to infection persistence or recurrence.
- Previous surgeries are common in patients presenting with pancreatic abscesses.
Purpose:
- To evaluate the efficacy and safety of extraperitoneal drainage for pancreatic abscesses.
- To assess the outcomes and complications associated with this surgical approach.
- To determine if extraperitoneal drainage can minimize peritoneal contamination and postoperative issues.
Summary:
- A study involving 12 patients (7 male, 5 female, average age 36) with pancreatic abscesses treated via extraperitoneal drainage.
- Common symptoms included fever, abdominal pain, and palpable masses; diagnostic imaging like CAT scans were crucial for localization.
- The extraperitoneal approach (anterior or posterior) was employed, with most patients experiencing complications managed conservatively. Overall mortality was 17%.
Impact:
- Extraperitoneal drainage is presented as a viable strategy for managing pancreatic abscesses.
- This method helps prevent peritoneal contamination, potentially reducing severe postoperative complications.
- The study suggests improved patient outcomes by avoiding direct peritoneal involvement during abscess management.