Pancreatic abscess.

Pancreatic abscess, although an uncommon complication of pancreatitis, is a serious cause of morbidity and death. During the 5-year period beginning in March 1976, 19 patients with pancreatic abscess were seen at the Ottawa Civic Hospital. Abdominal pain, mass, fever and leukocytosis were common; the serum amylase value was usually normal. twelve patients underwent external drainage; in 6 the abscess was drained internally through the posterior wall of the stomach. The overall mortality was 16%. Morbidity was high; 7 (37%) of the 19 patients required reoperation for recurrent sepsis. Differentiation of pancreatic abscess from phlegmonous pancreatitis or pseudocyst can be difficult. Ultrasonography may be useful but computerized axial tomography is the the diagnostic method of choice. Prompt débridement and external drainage are the mainstays of surgical treatment but internal drainage may be appropriate in selected patients.