Percutaneous intervention in acute pancreatitis

Interventional radiology has an important role to play in the management of local complications of acute pancreatitis, such as necrosis, pseudocyst, and abscess. Computed tomography (CT) is preferred for guiding pancreatic interventional procedures, with the most common access routes being through the left anterior pararenal space for pancreatic tail collections and through the gastrocolic ligament for pancreatic head and body collections. Pancreatic necrosis has a high mortality if infected, and the presence of infection must be determined with CT-guided needle aspiration. Careful planning of the access route is important to avoid the colon. Catheters of 8-12 F are usually sufficient for pseudocyst drainage. An average of 2-3 weeks drainage is required if there is no communication of the pseudocyst with the pancreatic duct and many weeks to months for pseudocysts with pancreatic duct communication. Percutaneous drainage of pseudocysts is associated with success rates of 80%-90%. Pancreatic abscess drainage has quoted success rates varying between 32% (infected necrosis) and 90% (pancreatic abscess). Use of large or multiple catheters is often required for complete drainage. The management of patients with severe acute pancreatitis is time-consuming and labor intensive for interventional radiologists, and a team approach with close communication with surgical personnel is required.