Pancreatic abscess: an unresolved surgical problem.

Twenty patients with pancreatic abscesses were studied to determine if recent diagnostic and therapeutic advances have improved the outlook for those with the disease. An abscess developed as a complication of alcoholic pancreatitis in 10 patients and was due to previous surgery in 9. Ultrasonography and computerized tomographic scanning of the abdomen were helpful in the diagnosis and localization of the abscesses. All 20 patients were treated surgically. Operative mortality was 30 percent and was due to multiple system failure from continuing sepsis. Only 2 of 15 patients who had sump drainage died compared with 3 of 4 patients who were drained with Penrose drains alone. There were two deaths among 10 patients who received nutritional support and four deaths in 10 patients who did not receive hyperalimentation. Pancreatic abscess remains a life-threatening condition. Ultrasonography and computerized tomographic scanning have helped in diagnoses and localization. The addition of sump drainage has reduced the mortality rate from 75 ot 13 percent. Nutritional support also appears to be helpful in reducing mortality.