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Experience With 100 Cases

Aaron S. Fink, MD; Jonathan R. Hiatt, MD; Henry A. Pitt, MD; Robert S. Bennion, MD; Luis R. DeSouza, MD; Robin D. McCoy, MPH; James H. Meyer, MD; Jesse E. Thompson, Jr, MD; Joseph L. Webster, MD; Samuel E. Wilson, MD

Arch Surg. 1988;123(9):1067-1072.

Abstract
• One hundred cases of pancreatic abscess were identified at five hospitals affiliated with UCLA between 1973 and 1985. Patients were included if a pancreatic mass or phlegmon followed an episode of pancreatitis, if the clinical impression was pancreatic abscess, and if drainage cultures were positive. Less than three Ranson's signs were present on admission in 72% of patients. The admission temperature was less than 38.3°C in 71% of patients, and 27% of patients never had a fever. Abdominal tenderness was absent in 40% of patients. The admission amylase concentrations and white blood cell counts were normal in 36% and 23% of patients, respectively. Extensive débridement, external drainage, and a low threshold for reoperation were the mainstays of surgical therapy. Twenty patients (20%) died, but Ranson's signs did not predict outcome. Pancreatic abscess may have an insidious presentation. A high index of suspicion, early computed tomographic scanning, and diagnostic needle aspiration may be necessary to establish this diagnosis.

(Arch Surg 1988;123:1067-1072)

Author Affiliations
From the Departments of Surgery (Drs Fink, Hiatt, Bennion, DeSouza, Thompson, and Wilson and Ms McCoy) and Medicine (Drs Meyer and Webster), UCLA School of Medicine, Los Angeles; and the Department of Surgery, The Johns Hopkins School of Medicine, Baltimore (Dr Pitt).

Footnotes
Accepted for publication May 18, 1988.

Read before the 59th Annual Meeting of the Pacific Coast Surgical Association, San Francisco, Feb 24, 1988.

Reprint requests to Room 72-256 CHS, UCLA Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90024-1749 (Dr Fink).

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