Surgical aspects of pancreatic abscess

In a retrospective study of all patients admitted with acute pancreatitis to a single hospital over the 10 year period 1975-1984, 22 patients operated upon for pancreatic abscess complicating acute pancreatitis were identified. The accuracy of the assessment by the surgeon of the extent of the abscess and the results of treatment by either local or wide drainage have been reviewed. The surgeon underestimated the extent of the abscess in 5 of the 22 patients. Four of these five patients were assessed as having a localized abscess presenting in the lesser sac and, in the other, the abscess was thought to be confined to the tail of the pancreas. Local exploration and drainage were performed in 13 patients and resulted in a high morbidity and mortality (54 per cent). Wide exploration was performed in nine patients with only two deaths, despite the greater extent of abscess formation. Improvement in outcome seen in the second 5 year period appears to be due to a more aggressive approach to exploration and drainage. The surgeon must be aware that abscesses in the lesser sac often signify more widespread abscess formation. Without wide exploration of the pancreas, assessment at laparotomy is likely to be unreliable. There appears to be additional benefit from wide drainage, even where abscess formation appears localized.