Pancreatic abscess management by subtotal resection and packing

A 20-year experience in management of 57 patients with pancreatic abscess was reviewed. Ages ranged from 17 to 91 years (average 46). Males outnumbered females 39 to 18. A prior episode of pancreatitis had been documented in 31 patients, trauma in 23, and no known cause in 3. All patients had fever (> 39°C), abdominal pain and/or tenderness, and absent peristalsis. A draining wound, abdominal mass, oliguria, (< 20 ml/hr), and shock (BP<100/60) were other prominent findings. Either leukocytosis (> 12,000/mm³) or leukopenia (<5,000/mm³) was noted in 56 patients. Elevation of the serum amylase (> 200 u/100 ml) and jaundice (bilirubin > 2 mg/100 ml) were reported less frequently. Bacteremia was found in all patients not receiving parenteral antibiotics at the time blood cultures were drawn and in half despite such therapy. Plain abdominal x-rays and, more recently, the computed tomography scan revealed retroperitoneal gas bubbles and/or a mass in 52 of the patients and proved to be the most useful diagnostic tests. Treatment with antibiotics alone or plus drainage led to survival in only 3 of 18. Five of 14 managed by open packing and 2 of 3 managed by distal resection with drainage died. However, when the wound following subtotal pancreatectomy was packed open, with daily pack changes, only 2 of 22 failed to survive. Deaths were primarily due to hemorrhagic (9) or septic (8) shock or some complication of these states (3).