Pancreatic abscess: importance of conventional radiology

To determine the clinical usefulness of conventional radiographic methods in pancreatic abscess, studies from 35 patients were retrospectively evaluated. Plain films of the abdomen were obtained in 31 and showed the diagnostic finding of extraluminal gas in the pancreatic area in 18 (58%). Gastrointestinal contrast studies were done in 28 patients and confirmed the extraluminal location of abscess gas in 17 (61%). These contrast studies provided important preoperative evidence of perforation or fistula in six (21%) patients. Because of the risk of extravasation in complicated pancreatic abscesses, water soluble contrast media are recommended instead of barium. Abscess gas was shown by computed tomography (CT) in four (50%) of eight patients and sonography suggested a diagnosis in five (31%) of 16. In aggregate all radiographic methods demonstrated evidence of a pancreatic abscess in 69%. While sonography and CT are being used with increasing frequency, this experience reaffirms the value of plain film and gastrointestinal contrast studies in patients with suspected pancreatic abscess.