Abstract
Pancreatic abscess is one of the infectious complications of acute pancreatitis. It is a collection principally containing pus, but it may also contain variable amounts of semisolid necrotic debris. Most of these abscesses evolve from the progressive liquefaction of necrotic pancreatic and peripancreatic tissues, but some arise from infection of peripancreatic fluid or collections elsewhere in the peritoneal cavity. Included also are abscesses found after surgical débridement and drainage of pancreatic necrosis. Although open surgical treatment of infected necrosis is the established treatment of choice, percutaneous drainage of abscesses is successful in some circumstances. We used percutaneous catheter drainage in 39 patients during 1987–1995. Only 9 of 29 (31%) attempts at primary therapy were successful; 2 patients died, and 18 required subsequent surgical drainage. On the other hand, 14 of 14 patients with recurrent or residual abscesses after surgical drainage were successfully drained percutaneously. Percutaneous catheter drainage of pancreatic abscesses may be useful for initial stabilization of septic patients, drainage of further abscesses after surgical intervention (especially when access for reoperation will be difficult), associated abscesses remote from the pancreas, and selected unilocular collections at a sufficient interval after necrotizing pancreatitis to have allowed essentially complete liquefaction.
Résumé
L’abcès pancréatique est une des complications infectieuses de la pancréatite aiguë. Il s’agit d’une collection contenant principalement du pus, mais elle peut également contenir une certaine quantité de débris semi-solides. La plupart de ces abcès proviennent d’une liquéfaction progressive de la nécrose pancréatique et péripancréatique mais, parfois, l’infection se développe à partir des collections péri ou extra —pancréatiques de la cavité péritonéale. On peut également voir des abcès post chirurgicaux après débridement chirurgical et drainage de la nécrose pancréatique. Alors que le traitement chirurgical de la nécrose infectée est le traitement de choix, le drainage percutané peut parfois être utilisée avec succès. Un drainage par cathéter percutané a été utilisé chez 39 patients pendant la période 1987–1995. Seulement 9 des 29 drainages (31%) tentés ont été des succès d’emblée; il y a eu deux décès et 18 patients ont nécessité un drainage chirurgical ultérieur. Par contre, les 14 patients ayant un abcès résiduel après drainage chirurgical ont tous pu être drainés avec succès par voie percutanée. Le drainage percutané des abcès pancréatiques peut être utile en première ligne, en attendant de pouvoir stabiliser le patient septique fragile, pour drainer les abcès résiduels après drainage chirurgical (surtout lorsque l’accès paraît problématique), pour des abcès distants et pour certaines collections uniloculaires survenant à distance après une pancréatite nécrosante en période de liquéfaction complète.
Resumen
El absceso pancreático es una de las complicaciones sépticas de la pancreatitis aguda. Se trata de una colección que contiene principalmente pus, pero también puede contener cantidades variables de material necrótico semisólido. La mayoría de los abscesos pancreáticos evolucionan a partir de la licuefacción de los tejidos pancreáticos y peripancreáticos necróticos, pero algunos se originan en la infectión de líquido o de colecciones peripancreáticas en otras ubicaciones en la cavidad peritoneal. También se incluyen abscesos que aparecen luego del desbridamiento o del drenaje de necrosis pancreática. Aunque el drenaje quirúrgico abierto es el tratamiento de electión en la necrosis pancreática infectada, el drenaje percutáneo de abscesos puede resultar exitoso en algunas circunstancias. Hemos utilizado drenaje percutáneo en 39 pacientes en el período 1987–1995. Sólo 9 de 29 (31%) intentos de usarlo como terapia primaria fueron exitosos, 2 pacientes murieron y 18 requirieron drenaje quirúrgico subsiguiente. Pero por otra parte, 14/14 pacientes con abscesos recurrentes o residuales fueron drenados exitosamente por la vía percutánea. El drenaje percutáneo con catéter de los abscesos pancreáticos puede ser de utilidad en la estabilización inicial de pacientes sépticos, en el drenaje de abscesos adicionales luego de intervención quirúrgica (especialmente cuando el acceso para la reoperación es dificil), en abscesos remotos asociados y en colecciones uniloculares seleccionadas, si se practica con un razonable intervalo luego de la pancreatitis necrotizante para permitir el proceso de lo que esencialmente viene a ser una licuefacción total.
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Mithöfer, K., Mueller, P.R. & Warshaw, A.L. Interventional and surgical treatment of pancreatic abscess. World J. Surg. 21, 162–168 (1997). https://doi.org/10.1007/s002689900209
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DOI: https://doi.org/10.1007/s002689900209