Management of pancreatic abscesses

The records of twenty-one patients treated for pancreatic abscesses were reviewed. Pancreatitis developed following alcohol ingestion, operative procedures, biliary tract disease, ulcers, and undetermined causes. The clinical findings included abdominal pain in 19 patients (90%); fever in 18 (86%); tenderness in 18 (86%); and leukocytosis in 18 (86%). Ultrasonographic examination aided the diagnosis in seven of 11 patients. Computerized tomography was useful in diagnosing eight of ten cases. There were twenty-nine hospital admissions, with a mean length of hospitalization of 76 days per patient. The operative findings varied with extent and duration of underlying pancreatitis. The surgical approach depended on clinical presentation and prior localization of the abscess. Eleven additional operations were performed. Complications included respiratory failure (three patients); fistula formation (five patients); hemorrhage (two patients); renal failure (one patient); and splenic vein thrombosis (one patient). Thirteen patients were treated with hyperalimentation and nine patients had gastrostomy and jejunostomy placed for decompression and feeding. Of 15 patients in whom microbial studies were reviewed, nine patients had polymicrobial infections. Three patients had Candida albicans. There was one death.