[Diagnosis and therapy of primary pancreatic abscess]

Abstract

Local septic complications in acute pancreatitis (AP) should be characterized and defined in order to assess the validity of early diagnosis and various therapeutic measures. The purpose of this study was therefore to distinguish between two local septic complications which have been termed 'abscess' and 'infected necrosis' in regard to their morphological, clinical, laboratory criteria. Moreover, the validity of various diagnostic procedures and therapeutic interventions were compared. Septic necrosis is defined as a diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue. The morphologic substrate of pancreatic abscess is a localized collection of pus surrounded by a capsula or pseudocapsula. Infected necrosis become clinically evident in the early phase of AP. The patients suffer from a fulminant course of AP with signs of sepsis and laboratory alterations typical for AP. Concomitantly, these patients develop pulmonary and renal insufficiency, in 71.5 and 44.2% of the patients, resp. Overall mortality rate of patients with infected necrosis amounts to 20.8%. In contrast, pancreatic abscess develops not before week 5 after onset of AP. Concomitantly, the laboratory signs of AP like amylasemia and hypocalcemia as well as LDH and C-reactive protein increases are rarely observed. Correspondingly, these patients suffer significantly less form pulmonary insufficiency (22.6%) or other organ complications. Consequently, the mortality rate is with 6.5% significantly lower. Timely diagnosis is possible with acceptable sensitivity by contrast-enhanced CT scan and fine-needle aspiration. Other imaging procedures do not show similar sensitivity and specificity. Therapeutically, patients with infected necrosis as well as pancreatic abscess have to be operated.(ABSTRACT TRUNCATED AT 250 WORDS)