The role of percutaneous external drainage in the treatment of fluid collections associated with severe acute pancreatitis. What, when and how to drain?

Abstract

The percutaneous drainage of the fluid collections associated with severe acute pancreatitis mainly in sterile cases is not a commonly accepted method. The aim of the present paper is to analyse the indications, the technic, the limits and results of the percutaneous drainage on the basis of the literature. The percutaneous drainage plays an important role in the treatment of the acute fluid collection, the acute pseudocyst, the pancreas abscess, and the liquified necrosis, accompanying the severe acute pancreatitis. For the septic fluid collections the percutaneous drainage is preferred as the first line treatment. In cases of sterile acute fluid collections and pseudocysts because of its relatively high iatrogenic infection rate the drainage is indicated only if it causes severe complaints. The rules of sterility have to be kept. For successful treatment of liquified necrosis the possible methods are the use of large-bore (20-30F) catheter drainage, sinus tract endoscopy, or laparoscopic assisted necrosectomy. In more than 25% of the cases drainage, along with the conservative treatment, leads to the complete recovery of the patient. In the remaining cases it is helpful in postponing the date of the operation and avoiding early surgery.