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Indolent Presentation of Pancreatic Abscess: Experience With 100 Cases

Indolent Presentation of Pancreatic Abscess: Experience With 100 Cases Abstract • One hundred cases of pancreatic abscess were identified at five hospitals affiliated with UCLA between 1973 and 1985. Patients were included if a pancreatic mass or phlegmon followed an episode of pancreatitis, if the clinical impression was pancreatic abscess, and if drainage cultures were positive. Less than three Ranson's signs were present on admission in 72% of patients. The admission temperature was less than 38.3°C in 71% of patients, and 27% of patients never had a fever. Abdominal tenderness was absent in 40% of patients. The admission amylase concentrations and white blood cell counts were normal in 36% and 23% of patients, respectively. Extensive débridement, external drainage, and a low threshold for reoperation were the mainstays of surgical therapy. Twenty patients (20%) died, but Ranson's signs did not predict outcome. Pancreatic abscess may have an insidious presentation. A high index of suspicion, early computed tomographic scanning, and diagnostic needle aspiration may be necessary to establish this diagnosis. (Arch Surg 1988;123:1067-1072) References 1. Altemeier WA, Alexander JW: Pancreatic abscess: A study of 32 cases . Arch Surg 1963;87:80-89.Crossref 2. Miller TA, Lindenauer SM, Frey CF, et al: Pancreatic abscess . Arch Surg 1974;108:545-551.Crossref 3. Camer SJ, Tan EGC, Warren KW, et al: Pancreatic abscess: A critical analysis of 113 cases . Am J Surg 1975;129:426-431.Crossref 4. Evans FC: Pancreatic abscess . Am J Surg 1969;117:537-540.Crossref 5. Becker JM, Pemberton JH, DiMagno EP, et al: Prognostic factors in pancreatic abscess . Surgery 1984;96:455-461. 6. Bolooki H, Jaffe B, Gliedman ML: Pancreatic abscess and lesser omental sac collections . Surg Gynecol Obstet 1968;126:1301-1308. 7. Aranha GV, Prinz RA, Greenlee HB: Pancreatic abscess: An unresolved surgical problem . Am J Surg 1982;144:534-538.Crossref 8. Ranson JHC: Acute pancreatitis . Curr Probi Surg 1979;16:1-84.Crossref 9. Ranson JHC, Pasternack BS: Statistical methods for quantifying the severity of clinical acute pancreatitis . J Surg Res 1977;22:79-91.Crossref 10. Stone HH, Strom PR, Mullins RJ: Pancreatic abscess management by subtotal resection and packing . World J Surg 1984;8:340-345.Crossref 11. Bradley EL: Management of infected pancreatic necrosis . Ann Surg 1987;206:542-550.Crossref 12. Pemberton JH, Becker JM, Dozois RR, et al: Controlled open lesser sac drainage for pancreatic abscess . Ann Surg 1986;203:600-604.Crossref 13. Warshaw AL, Jin G: Improved survival in 45 patients with pancreatic abscess . Ann Surg 1985;202:408-417.Crossref 14. Donahue PE, Nyhus LE, Baker RJ: Pancreatic abscess after alcoholic pancreatitis . Arch Surg 1980;115:905-909.Crossref 15. Ranson JHC, Spencer FC: Prevention, diagnosis, and treatment of pancreatic abscess . Surgery 1977;82:99-106. 16. Holden JL, Berne TV, Rosoff L Sr: Pancreatic abscess following acute pancreatitis . Arch Surg 1976;111:858-861.Crossref 17. Maroske D, Roher HD: Pancreatic abscess . Dig Surg 1985;2:192-199.Crossref 18. Shi ECP, Yeo BW, Ham JM: Pancreatic abscess . Br J Surg 1984;71:689-691.Crossref 19. Blarney SL, Imrie CW, O'Neill J, et al: Prognostic factors in acute pancreatitis . Gut 1984;25:1340-1346.Crossref 20. Corfield AP, Williamson RCN, McMahon MJ, et al: Prediction of severity in acute pancreatitis: Prospective comparison of three prognostic indices . Lancet 1985;2:403-407.Crossref 21. Beger HG, Bittner R, Block S, et al: Bacterial contamination of pancreatic necrosis . Gastroenterology 1986;91:433-438. 22. Beger HG, Kunz P, Bittner R: Prognostic criteria in necrotizing pancreatitis , in Beger HG, Buchler M (eds): Acute Pancreatitis . New York, Springer-Verlag NY Inc, 1987, pp 198-200. 23. Bittner R, Block S, Buchler M, et al: Pancreatic abscess and infected necrosis: Different local septic complications in acute pancreatitis . Dig Dis Sci 1987;32:1082-1087.Crossref 24. Buchler M, Uhl W, Malfertheiner P: Biochemical staging of acute pancreatitis , in Beger HG, Buchler M (eds): Acute Pancreatitis . New York, Springer-Verlag NY Inc, 1987, pp 143-153. 25. Block S, Maier W, Bittner R, et al: Identification of pancreas necrosis in severe acute pancreatitis: Imaging procedures vs clinical staging . Gut 1986;27:1032-1042.Crossref 26. Nordestgaard AG, Wilson SE, Williams RW: Early computed tomography as a predictor of outcome in acute pancreatitis . Am J Surg 1986; 152:1127-1132.Crossref 27. Ranson J, Balthazar E, Caccavale R, et al: Computed tomography and the prediction of pancreatic abscess in acute pancreatitis . Ann Surg 1985;201:656-663.Crossref 28. Hiatt JR, Fink AS, King W III, et al: Percutaneous aspiration of peripancreatic fluid collections: A safe method to detect infection . Surgery 1987;101:523-530. 29. Gerzof SG, Banks PA, Robbins AH, et al: Early diagnosis of pancreatic infection by computer tomography—guided aspiration . Gastroenterology 1987;93:1315-1320. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Indolent Presentation of Pancreatic Abscess: Experience With 100 Cases

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References (32)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1988.01400330043006
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Abstract

Abstract • One hundred cases of pancreatic abscess were identified at five hospitals affiliated with UCLA between 1973 and 1985. Patients were included if a pancreatic mass or phlegmon followed an episode of pancreatitis, if the clinical impression was pancreatic abscess, and if drainage cultures were positive. Less than three Ranson's signs were present on admission in 72% of patients. The admission temperature was less than 38.3°C in 71% of patients, and 27% of patients never had a fever. Abdominal tenderness was absent in 40% of patients. The admission amylase concentrations and white blood cell counts were normal in 36% and 23% of patients, respectively. Extensive débridement, external drainage, and a low threshold for reoperation were the mainstays of surgical therapy. Twenty patients (20%) died, but Ranson's signs did not predict outcome. Pancreatic abscess may have an insidious presentation. A high index of suspicion, early computed tomographic scanning, and diagnostic needle aspiration may be necessary to establish this diagnosis. (Arch Surg 1988;123:1067-1072) References 1. Altemeier WA, Alexander JW: Pancreatic abscess: A study of 32 cases . Arch Surg 1963;87:80-89.Crossref 2. Miller TA, Lindenauer SM, Frey CF, et al: Pancreatic abscess . Arch Surg 1974;108:545-551.Crossref 3. Camer SJ, Tan EGC, Warren KW, et al: Pancreatic abscess: A critical analysis of 113 cases . Am J Surg 1975;129:426-431.Crossref 4. Evans FC: Pancreatic abscess . Am J Surg 1969;117:537-540.Crossref 5. Becker JM, Pemberton JH, DiMagno EP, et al: Prognostic factors in pancreatic abscess . Surgery 1984;96:455-461. 6. Bolooki H, Jaffe B, Gliedman ML: Pancreatic abscess and lesser omental sac collections . Surg Gynecol Obstet 1968;126:1301-1308. 7. Aranha GV, Prinz RA, Greenlee HB: Pancreatic abscess: An unresolved surgical problem . Am J Surg 1982;144:534-538.Crossref 8. Ranson JHC: Acute pancreatitis . Curr Probi Surg 1979;16:1-84.Crossref 9. Ranson JHC, Pasternack BS: Statistical methods for quantifying the severity of clinical acute pancreatitis . J Surg Res 1977;22:79-91.Crossref 10. Stone HH, Strom PR, Mullins RJ: Pancreatic abscess management by subtotal resection and packing . World J Surg 1984;8:340-345.Crossref 11. Bradley EL: Management of infected pancreatic necrosis . Ann Surg 1987;206:542-550.Crossref 12. Pemberton JH, Becker JM, Dozois RR, et al: Controlled open lesser sac drainage for pancreatic abscess . Ann Surg 1986;203:600-604.Crossref 13. Warshaw AL, Jin G: Improved survival in 45 patients with pancreatic abscess . Ann Surg 1985;202:408-417.Crossref 14. Donahue PE, Nyhus LE, Baker RJ: Pancreatic abscess after alcoholic pancreatitis . Arch Surg 1980;115:905-909.Crossref 15. Ranson JHC, Spencer FC: Prevention, diagnosis, and treatment of pancreatic abscess . Surgery 1977;82:99-106. 16. Holden JL, Berne TV, Rosoff L Sr: Pancreatic abscess following acute pancreatitis . Arch Surg 1976;111:858-861.Crossref 17. Maroske D, Roher HD: Pancreatic abscess . Dig Surg 1985;2:192-199.Crossref 18. Shi ECP, Yeo BW, Ham JM: Pancreatic abscess . Br J Surg 1984;71:689-691.Crossref 19. Blarney SL, Imrie CW, O'Neill J, et al: Prognostic factors in acute pancreatitis . Gut 1984;25:1340-1346.Crossref 20. Corfield AP, Williamson RCN, McMahon MJ, et al: Prediction of severity in acute pancreatitis: Prospective comparison of three prognostic indices . Lancet 1985;2:403-407.Crossref 21. Beger HG, Bittner R, Block S, et al: Bacterial contamination of pancreatic necrosis . Gastroenterology 1986;91:433-438. 22. Beger HG, Kunz P, Bittner R: Prognostic criteria in necrotizing pancreatitis , in Beger HG, Buchler M (eds): Acute Pancreatitis . New York, Springer-Verlag NY Inc, 1987, pp 198-200. 23. Bittner R, Block S, Buchler M, et al: Pancreatic abscess and infected necrosis: Different local septic complications in acute pancreatitis . Dig Dis Sci 1987;32:1082-1087.Crossref 24. Buchler M, Uhl W, Malfertheiner P: Biochemical staging of acute pancreatitis , in Beger HG, Buchler M (eds): Acute Pancreatitis . New York, Springer-Verlag NY Inc, 1987, pp 143-153. 25. Block S, Maier W, Bittner R, et al: Identification of pancreas necrosis in severe acute pancreatitis: Imaging procedures vs clinical staging . Gut 1986;27:1032-1042.Crossref 26. Nordestgaard AG, Wilson SE, Williams RW: Early computed tomography as a predictor of outcome in acute pancreatitis . Am J Surg 1986; 152:1127-1132.Crossref 27. Ranson J, Balthazar E, Caccavale R, et al: Computed tomography and the prediction of pancreatic abscess in acute pancreatitis . Ann Surg 1985;201:656-663.Crossref 28. Hiatt JR, Fink AS, King W III, et al: Percutaneous aspiration of peripancreatic fluid collections: A safe method to detect infection . Surgery 1987;101:523-530. 29. Gerzof SG, Banks PA, Robbins AH, et al: Early diagnosis of pancreatic infection by computer tomography—guided aspiration . Gastroenterology 1987;93:1315-1320.

Journal

Archives of Surgery – American Medical Association

Published: Sep 1, 1988

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