Prognostic factors in pancreatic abscess.

Pancreatic abscess is a highly lethal sequela of pancreatitis. The purpose of this study was to identify clinical and laboratory factors associated with the antecedent episode of pancreatitis or at the time of manifestation of a pancreatic abscess and factors related to its treatment that might have prognostic significance. The records of 66 consecutive patients with pancreatic abscess seen between 1966 and 1980 were reviewed. Factors adversely affecting survival included: severity of precipitating pancreatitis (p less than 0.03); sepsis and pulmonary dysfunction (p less than 0.05); and persistent postoperative sepsis (p less than 0.001). All four patients who were treated nonsurgically died. Of 62 patients treated surgically, 80% experienced serious complications, 31% required reoperations, and 40% died. No single surgical procedure, including marsupialization, proved to be superior. Surgical drainage offers the only possibility of survival for patients with pancreatic abscess. More thorough elimination of all focuses of infection is required, however, to reduce the high morbidity and mortality rates associated with persistent postoperative sepsis.