Percutaneous drainage of pancreatic necrosis: is it ecstasy or agony?

The above comments are meant to help the reader further analyze the fine study of Freeny et al. [1]. To my knowledge, this is the first series to specifically define its patients correctly as having pure pancreatic necrosis. This work represents a thorough analysis of a difficult problem and points out how to treat these patients if one wants to be successful. This template is important to radiologists who wish to get involved with this type of patient. What Freeny et al. truly describe is the agony and ecstasy involved with this difficult undertaking. Radiologists can obtain a lot of satisfaction in taking care of this type of patient, but they and the referring physicians must be committed. The patient, the referring physician, and the radiologist must also face the agony in dealing with the illness. They must be ready to handle the number of catheters, the number of catheter changes, the number of CT scans, and the duration of drainage. In some cases percutaneous drainage will work; in some cases it is the only alternative for a patient with this disease. In other cases a catheter or two can be placed, but they might not be as beneficial to the patient as surgery. Clearly, percutaneous drainage of pancreatic necrosis can be done, and radiologists must work with their clinical colleagues to decide whether it is in the patient's best interest.