Percutaneous radiologic drainage of pancreatic abscesses.

vanSonnenberg, Eric; Wittich, G R; Chon, Kenneth S.; D'Agostino, H B; Casola, Giovanna; Easter, David W.; Morgan, Robert; Walser, Eric; Nealon, William H.; Goodacre, Brian; Stabile, Bruce E.

doi:10.2214/ajr.168.4.9124154

Cited by 115 publications

(45 citation statements)

References 22 publications

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“…30 -35 van Sonnenberg et al's 30 1997 report of 59 patients with pancreatic abscess, as defined by the Atlanta group, treated with PCD found an 86% success rate with drainage and antibiotics, an improvement over the 69% reported in their 1985 report. 31 They reported that only 7 of 59 patients (12%) required operation, and the overall death rate was 8%.…”

Section: Discussionmentioning

confidence: 98%

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

et al. 2000

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ObjectiveTo assess the treatment of peripancreatic fluid collections or abscess with percutaneous catheter drainage (PCD). Summary Background DataSurgical intervention has been the mainstay of treatment for infected peripancreatic fluid collections and abscesses. Increasingly, PCD has been used, with mixed results reported in the literature. MethodsA retrospective chart review of 1993 to 1997 was performed on 82 patients at a tertiary care public teaching hospital who had computed tomography-guided aspiration for suspected infected pancreatic fluid collection or abscess. Culture results, need for subsequent surgical intervention, length of stay, and death rate were assessed. ResultsOne hundred thirty-five aspirations were performed in 82 patients (57 male patients, 25 female patients) with a mean age of 40 years (range 17-68). The etiologies were alcohol (41), gallstones (32), and other (9). The mean number of Ranson's criteria was four (range 0 -9). All patients received antibiotics. Forty-eight patients had evidence of pancreatic necrosis on computed tomography scan. Cultures were negative in 40 patients and positive in 42. Twenty-five of the 42 culture-positive patients had PCD as primary therapy, and 6 required subsequent surgery. Eleven patients had primary surgical therapy, and five required subsequent surgery. Six patients were treated with only antibiotics. The death rates were 12% for culture-positive patients and 8% for the entire 82 patients. ConclusionsHistorically, patients with positive peripancreatic aspirate culture have required operation. This series reports an evolving strategy of reliance on catheter drainage. PCD should be considered as the initial therapy for culture-positive patients, with surgical intervention reserved for patients in whom treatment fails.Historically, the presence of an infected peripancreatic fluid collection or pancreatic abscess has mandated operation. Primary surgical treatment is successful for most patients, but the death rate is reportedly 15% to 80%, and surgery is associated with reoperation and prolonged lengths of stay.1 It has been more than 20 years since the treatment of pancreatic abscess was reviewed at our institution.2 In that report, Holden et al identified a death rate of 50% among 28 patients treated operatively and a complication rate of 93%.The availability of percutaneous catheter drainage (PCD) under radiologic guidance has replaced surgical drainage as the primary treatment of intraabdominal and hepatic abscesses. 3 A natural progression of the use of PCD has been its application for peripancreatic fluid collections and abscess. To ascertain the relative merits of PCD and to guide patient selection, we performed a retrospective chart review of patients with peripancreatic fluid collections or pancreatic abscess who had computed tomography (CT)-guided aspiration.

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Section: Discussionmentioning

confidence: 98%

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

et al. 2000

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“…Differentiation of pancreatic abscess from WOPN or pseudocyst is important clinically, because the management is often different. Pancreatic abscess can be managed with endoscopic or CT-guided percutaneous therapy with a higher success rate than WOPN [17,23], because at least by the definition of the Atlanta classification, they lack any solid content.…”

Section: Discussionmentioning

confidence: 99%

CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy

et al. 2008

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Computed tomography (CT) findings that may differentiate walled-off pancreatic necrosis (WOPN) from pancreatic pseudocyst were investigated. CT examinations performed before endoscopic therapy of pancreatic fluid collection (PFC) in 73 patients (45 WOPN, 28 pseudocysts) were evaluated retrospectively by two radiologists. PFC was evaluated for size, extension to paracolic space, characteristics of wall and internal structure. The pancreas was evaluated for deformity or discontinuity, and pancreatic duct dilation. CT findings that were associated with WOPN or pseudocyst were identified. CT score (number of CT findings associated with WOPN minus number of findings associated with pseudocyst) was calculated for each PFC. PFC was categorized as WOPN or pseudocyst using a CT score threshold. Larger size, extension to paracolic space, irregular wall definition, presence of fat attenuation debris in PFC, pancreatic deformity or discontinuity (P < 0.05-0.0001) were findings associated with WOPN. Presence of pancreatic duct dilation was associated with pseudocyst. Using a CT score of 2 or higher as a threshold, CT differentiated WOPN from pseudocyst with an accuracy of 79.5-83.6%. Thus, CT can differentiate WOPN from pseudocysts.

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“…Nine original articles after 1993 were identified that reported on the treatment of 'pancreatic abscesses', and the Atlanta definition (collection of pus and virtually no necrotic debris, more than 4 weeks after onset) was strictly applied in three of these 134 -136 . The others included collections that contained, in addition to pus, solid necrotic debris 137 -139 or that were treated within 4 weeks of onset of disease 140 or after surgery 141,142 . The diagnosis of pancreatic abscess on CECT is also controversial.…”

Section: Pancreatic Abscessmentioning

confidence: 99%

The Atlanta Classification on Acute Pancreatitis Revisited

Bollen

Santvoort²,

Besselink³

et al. 2006

Pancreas

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Results: A total of 447 articles was assessed, including 12 guidelines and 82 reviews. Alternative definitions of predicted severity of acute pancreatitis, actual severity and organ failure were used in more than half of the studies. There was a large variation in the interpretation of the Atlanta definitions of local complications, especially relating to the content of peripancreatic collections. Conclusion:The Atlanta definitions for acute pancreatitis are often used inappropriately, and alternative definitions are frequently applied. Such lack of consensus illustrates the need for a revision of the Atlanta Classification.

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Percutaneous radiologic drainage of pancreatic abscesses.

Cited by 115 publications

References 22 publications

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy

The Atlanta Classification on Acute Pancreatitis Revisited

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