Pancreatic fluid collections: diagnostic and therapeutic implications of percutaneous drainage guided by ultrasound

The aim of the present study is to assess the usefulness of biochemical and bacteriological analysis of the pancreatic fluid obtained at percutaneous drainage of pancreatic pseudocysts and abscesses guided by ultrasound.

The study population was comprised of 65 patients, aged 21-79 years: 18 with abscesses and 47 with pseudocysts. In all cases the etiological factor of pancreatic fluid collections was acute pancreatitis. Microbiological (both of aerobic and anaerobic flora), biochemical (including alpha 2-macroglobulin) and cytological analysis of aspirated fluid was performed. Duration of percutaneous drainage in pseudocysts was 10-40 days (mean 18 +/- 12) and in abscesses 21-56 days (mean 32 +/- 19).

Complete resolution of pancreatic fluid collections was obtained in 54 (83%) patients, among them in 40 (85.1%) with pseudocysts and in 14 (77.7%) with abscesses, which was confirmed in follow-up ultrasound and/or computed tomography one year after the catheter was removed. Mild complications of this procedure observed in 17 (26.1%) patients were managed without catheter removal. A variety of organisms were cultured from pancreatic fluid, E. coli being the most prevalent. Enterobacter cloacae, staphylococcus aureus, staphylococcus epidermidis, peptococcus saccharolyticus, propionibacterium acnes and bacteroides fragilis were also isolated. Cytologic analysis of the aspirate revealed no atypical cells. The level of alpha 2-macroglobulin in the pancreatic fluid was significantly higher (p < 0.05) in patients with successful pancreatic drainage as compared to the remaining group.

Percutaneous drainage represents a safe therapeutic method that also provides additional criteria for the management of patients with pancreatic cystic lesions.