Komplikationen der akuten Pankreatitis: Abszeß und Pseudozyste

Abstract

Complications of acute pancreatits such as development of necrosis, infection, pancreatic abscess, a circumscribed liquid collection of pus are the primary determinants of outcome. Diagnostic aspiration of pancreatic collections is of value in establishing the presence or absence of infection. Because no case of pancreatic abscess has ever been cured by supportive treatment as antibiotics alone, the finding of infection is a absolute indication for a intervention. Percutaneous catheter drainage is an efficacious method to treat pancreatic abscess. A different morphological entity is the infected pancreatic necrosis that can be morphologically classified as solid nonperfused dead tissue. Most of the patients with pancreatic infections show a protean manifestation of necrotizing pancreatitis morphologically varying from abscess over fluid collections to solid unperfused tissue, a mixture of solid and liquid components. A differentiation between abscess and infected necrosis is often difficult and ‘somewhat artificial’. Infected solid material can not be evacuated through a catheter. Simple abscess can be treated with percutaneous drainage, solid necrosis need surgical debriment. Pancreatic pseudocysts are a common complication of acute and chronic pancreatitis. Until the advent of computed tomography and laparoscopic surgery, the management of pseudocysts has evolved over the past 15 years. The natural history of pancreatic pseudocysts includes an early phase of 8 weeks during which a spontaneous resolution is possible. Maturation of the pseudocyst wall occur with pseudocyst resistance. Untreated pseudocysts have been associated with a 40% complication rate, including abscess, fistulae, spontaneous rupture, massive bleeding, and death. The management of symptomatic pancreatic pseudocysts include, decompression by external and internal drainage into the alimentary tract (stomach, duodenum, jejunum) and in a few pancreatic pseudocyst resection.