Drainage of Pancreatic Abscess and Fluid Collections

Abstract

Pancreatic fluid collections represent a diverse group of lesions of various causes, severity, and treatments. Most common causes include acute and chronic pancreatitis and less commonly pancreatic trauma and collections post-pancreatic surgery. Based on their pathologic changes and the imaging findings pancreatic fluid collections are divided into four types (Atlanta classification). Acute fluid collections occur early in the course of acute pancreatitis and lack a wall of fibrous or granulation tissue. The majority resolves spontaneously and do not need intervention. The collections, which persist for 4–6 weeks will progress to become pseudocysts and if infected abscesses. Pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous and granulation tissue. Pancreatic necrosis is a focal or diffuse area of nonviable pancreatic parenchyma that is usually associated with peripancreatic fat necrosis. Pancreatic abscess is a circumscribed collection of pus typically in proximity to the pancreas containing little or no pancreatic necrosis. Pancreatic abscesses include infected pseudocysts, late infected fluid collections, and postoperative collections.