Open treatment of pancreatic abscess

Twenty-one consecutive patients with pancreatic abscess were managed by an open packing technique. Despite an anticipated mortality of less than 65 per cent predicted by Ranson's prognostic signs, the mortality in this group of patients was only 14 per cent. The marked improvement in results was attributed to several factors: earlier diagnosis and surgical intervention based upon serial abdominal tomography; prevention of persistent or recurrent sepsis by frequent scheduled dressing changes, and prevention of frequently related complications. Seven patients were found to have significant anaerobic involvement. All wounds were permitted to heal by secondary intention, and each patient received intravenous hyperalimentation. The average duration of hospitalization was 76 days, a period not differing significantly from that required by conventional closed methods of drainage. Open packing of pancreatic abscesses appears to represent a significant advance in the management of these difficult patients.