Pancreatic juice in the peritoneal cavity: antibiotics or omental preservation prevent mortality.

Pancreatic juice without bile will accumulate if the pancreatic duct communicates with the peritoneal cavity. We tested the effect of antibiotics or omentectomy on mortality in dogs where the pancreatic duct drained into the peritoneal cavity. Under sterile conditions the head of the pancreas was excised, the duodenum was preserved, and the body and tail of the pancreas remained in situ. The pancreatic duct was either ligated or left open to drain into the peritoneal cavity. Thirty-two dogs were prepared and divided into four groups by the status of the pancreatic duct, the use of omentectomy, or the administration of two doses of penicillin G procaine (20,000 units/kg) given before and then 24 hr after operation. The dogs were observed for mortality over a 1-month period. If a mortality occurred, the etiology was determined at autopsy. After excision of the omentum, the mortality rate was significantly higher if the pancreatic duct was allowed to drain into the peritoneal cavity than if the duct was ligated. Mortality decreased within the duct open group if only antibiotics were given (significant) or if only the omentum was preserved (not significant). This study indicates the importance of bacterial contamination or omental function when pancreatic juice is present in the peritoneal cavity.