Percutaneous catheter drainage of infected pancreatic and peripancreatic fluid collections
D. B. Adams, T. S. Harvey and M. C. Anderson
Department of Surgery, Veterans Administration Medical Center, Charleston, SC 29425.
Operative drainage is the cornerstone of therapy for pancreatic abscess.
Recently it has been suggested that successful percutaneous catheter
drainage of infected pancreatic and peripancreatic fluid collections may
serve as definitive therapy. We undertook therapeutic, computed
tomography-directed percutaneous drainage in a selected group of 29
patients with infected pancreatic and peripancreatic fluid collections.
Twenty-three patients (79%) were successfully treated with percutaneous
drainage. Of six patients (21%) representing failures of percutaneous
drainage, four died and two recovered after operative drainage. The four
patients who died had a mean APACHE (acute physiology and chronic health
evaluation) II score of 23 and five of Ranson's prognostic signs. Ranson's
signs and APACHE II scores were predictive of success and mortality. We
conclude that in selected patients, infected pancreatic and peripancreatic
fluid collections can be treated definitively with therapeutic percutaneous
catheter drainage. Based on this experience, recommendations regarding
patient selection are included.
