Indolent Presentation of Pancreatic Abscess

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

doi:10.1001/archsurg.1988.01400330043006

Cited by 29 publications

(7 citation statements)

References 22 publications

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“…[18][19][20] Nevertheless, an exact prediction of a further infection is difficult in the early phase of the ANP. In our series, CT signs of peripancreatic necrosis were constant on admission to the hospital and were the basis for the inclusion of the patients in this study.…”

Section: Mortalitymentioning

confidence: 99%

“…[14][15][16][17] A major risk of bacterial contamination exists when a peripancreatic necrosis is present, depending on its extent and the duration of the disease. [18][19][20] Nevertheless, an exact prediction of a further infection is difficult in the early phase of the ANP. In our series, CT signs of peripancreatic necrosis were constant on admission to the hospital and were the basis for the inclusion of the pa-tients in this study.…”

Section: Commentmentioning

confidence: 99%

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Retroperitoneal Approach and Endoscopic Management of Peripancreatic Necrosis Collections

Gambiez

Denimal²,

Porte³

et al. 1998

Arch Surg

113

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To review the results of the different modalities of treatment of acute necrotizing pancreatitis that have been used by a single team during a 6-year period to assess the technique and indications of an endoscopic method of retroperitoneal drainage that is routinely performed for the management of peripancreatic necrosis.Design and Setting: Retrospective study of 53 patients in a tertiary care center.Results: All patients had signs of peripancreatic necrosis on initial computed tomography scan, 20 patients experienced organ failure during the first 7 days of the disease, and bacterial contamination was proved in 22 (56%) of 39 samples of peripancreatic necrosis. Methods of treatment included supportive therapy alone (group 1), percutaneous drainage (group 2), endoscopic retroperitoneal drainage (group 3), and laparotomy and transperitoneal drainage (group 4). Mortality and mean hospital stay were as follows: group 1, 0% and 23 days; group 2, 20% and 89 days; group 3, 10% and 62 days; and group 4, 33% and 86 days. Percutaneous drainage was beneficial in only 3 cases of sterile collection. Two local complications were related to the method of endoscopic drainage. Primary laparotomy was not routinely performed except in patients with an intraperitoneal complication. Overall mortality was 13.2%; mortality was significantly higher in patients with an infected necrosis (32%). Conclusions:The use of endoscopic retroperitoneal drainage seemed to be a significant factor in the observed improvement by providing a reliable drainage of the peripancreatic areas and avoiding the opening of the peritoneal cavity. This surgical approach is not exclusive and may be combined with a secondary laparotomy when needed. The preferred indications of this method are heterogeneous collections of necrosis with bacterial contamination.

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Section: Mortalitymentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Retroperitoneal Approach and Endoscopic Management of Peripancreatic Necrosis Collections

Gambiez

Denimal²,

Porte³

et al. 1998

Arch Surg

113

View full text Add to dashboard Cite

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“…Most of these trials (7-9) elicited decreased morbidity or lower frequency of septic complications (SC) but no decrease in mortality. The diagnosis of SC during AP is currently based on bacterial isolation by fineneedle aspiration guided by computed tomography (CT) scan (10)(11)(12)(13)(14)(15) because other signs (fever, leukocytosis, gas bubbles in pancreatic necrosis) are either non-specific or poorly sensitive (14,15). As the indications for early antibiotic treatment are at present obtained only in severe AP, it could be of interest to predict SC as soon as possible by simple and early serum markers.…”

mentioning

confidence: 99%

Value of Early Blood Th-1 Cytokine Determination in Predicting Severity of Acute Pancreatitis

HERESBACH¹

1998

Scandinavian Journal of Gastroenterology

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“…Fink et al described their experience with 100 cases of pancreatic abscesses with indolent presentations. Although a microbiological cause was sought in all cases, no diagnosis of TB was made in any of them (39). This may reflect both the rarity of the condition and the need for special stains and culture media for the diagnosis of TB.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous Pancreatic Abscess in an HIV Antibody-negative Patient: Case Report and Review

Jenney

Pickles²,

Hellard³

et al. 1998

Scandinavian Journal of Infectious Diseases

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Tuberculosis (TB) is most commonly diagnosed as a pulmonary disease; however, haematogenous spread of the organism can cause disease in any organ system. We report the case of a 30-y-old woman, Human Immunodeficiency Virus (HIV) antibody-negative, who was diagnosed as having a pancreatic mass on computed tomographic (CT) scans. She underwent a laparotomy and the fluid drained from the mass was culture-positive for Mycobacterium tuberculosis. We review the clinical details of 37 similar cases of pancreatic TB in the literature, where each patient's HIV antibody status is negative or unknown. In this series 3 patients died (1 of these had commenced anti-TB therapy, the others had not) but the remaining 34 responded well to radiological-guided drainage and/or surgical intervention and anti-TB therapy. TB should be considered in the differential diagnosis of a pancreatic mass, especially when associated with epigastric pain or discomfort and weight loss.

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Indolent Presentation of Pancreatic Abscess

Cited by 29 publications

References 22 publications

Retroperitoneal Approach and Endoscopic Management of Peripancreatic Necrosis Collections

Retroperitoneal Approach and Endoscopic Management of Peripancreatic Necrosis Collections

Value of Early Blood Th-1 Cytokine Determination in Predicting Severity of Acute Pancreatitis

Tuberculous Pancreatic Abscess in an HIV Antibody-negative Patient: Case Report and Review

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