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HP06
PANCREATIC ABSCESS: RESULTS OF A SURGEON’S PROTOCOL
Author(s) -
Smith R. C.,
Pender S.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04122_6.x
Subject(s) - medicine , abscess , etiology , surgery , pancreatitis
A standardized management has been adopted for management of pancreatic abscess, where TPN was used to maintain nutritional status and ICU for maintenance of homeostasis until the junction between the abscess and viable tissue demarcated. Surgical intervention was undertaken if resolution was unlikely after 2 weeks and the patient was deteriorating. This involved a complete sequestrectomy with careful drainage. Flagyl was preferred for prophylaxis when cholangitis was not a factor and gut rest with TPN was used to maintain nutritional status. A review of the results over the last 7 years is presented. 31 (16 male and 15 female) patients required surgical intervention. Their ages ranged from 18 to 88 years with a mean (sd) of 58 (18) years. The aetiology was biliary in 17, alcohol in 11 postoperative in 3 and 2 had other causes. The Apache II scores on admission was 13.8 (5.0) and 14.5 (5.2) preoperatively. There were 5 deaths (13%) which occurred in patients aged 34, 58, 83, 76, and 78 years. They presented with ApacheII scores of 20, 18, 15, 24, 16 respectively and 3 had significant co‐morbidities. The median hospital stay was 47 (7–132) days. Only 3 patients required a re‐operation for incomplete sequestrectomy. They required TPN for from 7 to 64 days (median 20 IQR 11–32 days). Conclusion: Delaying surgery until there is good demarcation between the sequestrum and the normal tissue allows for a more aggressive surgical approach even in patients with severe pancreatitis and high ApacheII scores. Age is an important determinant of death but some elderly patients survive this serious illness.