Pancreatic abscess: 10-year experience at the University of South Florida

Pancreatic abscess is an uncommon but often catastrophic complication of acute pancreatitis. This study reviews the past 10 yr experience at the University of South Florida Teaching Hospitals involving patients diagnosed to have pancreatic abscess. The etiology, management, complications, and factors affecting mortality are discussed. The results indicate: the presentation of pancreatic abscess is variable; increased positive prognostic signs (by Ranson's criteria) on initial presentation correlate with increased mortality; complications are common (80%) and contribute significantly to morbidity and mortality; CT scan is more accurate than ultrasound in the diagnosis of pancreatic abscess; poorly localized phlegmonous pancreatic slough noted by CT scan, sonography, or exploratory laparotomy, carries a higher mortality than a well-localized purulent collection; negative blood cultures or abscess cultures do not rule out pancreatic abscess; infection of lesser sac fluid collections can occur in the hospital implying that strict attention must be paid to nosocomial infections; the timing of surgical drainage is critical, recurrent abscess requires repeat surgery, and resection is associated with a very high mortality (reflecting greater severity of underlying disease); there has been no change in mortality of pancreatic abscess in the last 10 yr.