Pancreatic abscess.

Compared with the general hospital population of patients with pancreatitis, patients with biliary tract or peptic ulcer disease have de novo pancreatic abscesses develop more commonly than patients with alcoholic pancreatitis. The apparent greater predisposition of the patient with biliary tract or peptic ulcer disease to infection does not seem to be due so much to these patients having potential sources of infection, such as an infected biliary tract or leaking ulcer, as to the fact that many patients with alcoholism and hemorrhagic pancreatitis never survive the fluid loss phase of pancreatitis long enough to have a secondary infection and abscess. The mortality associated with the development of de novo pancreatic abscesses is higher in patients with biliary disease, peptic ulcer or idiopathic pancreatitis in comparison with those patients with alcoholic pancreatitis. Some complications of pancreatic abscesses, such as renal failure, may be avoided through appropriate management of fluid losses during the hemorrhagic phase of pancreatitis preceding absecess formation. Good medical management and aggressive use of newer diagnostic and therapeutic modalities may reduce the mortality and complications of pancreatic abscess. Prompt drainage of an abscess once identified is essential to survival. Proximal colostomy or ileostomy is indicated in the patient with a colonic fistula. Large particulate chunks of necrotic pancreas are not easily evacuated through Penrose, cigarette or sump drains. Marsupialization of the abscess may be considered in patients with this type of abscess.