Endoscopic treatment of multiple pancreatic abscesses case report and review of the literature.
OBJECTIVE
Pancreatic abscesses are treated surgically and the role of endotherapy is still to be established. We describe the case of successful endoscopic management of two pancreatic abscesses in a critically ill patient.


METHODS
A patient was admitted to the hospital for severe acute pancreatitis. One month later the patient developed pancreatic sepsis. CT scan showed two large abscesses. The first was bulging to the posterior wall of the stomach and another at the tail of the pancreas. Parenteral antibiotic therapy was administered. The clinical status of the patient rapidly deteriorated and the patient was unfit for surgical intervention. The endoscopic retrograde cholangiopancreatography was performed. The pancreatic duct communicated with the abscess at the tail of the pancreas. The drainage of this abscess was done transpapillarily. Endoscopic cystogastrostomy was performed to treat the pancreatic abscess that bulged to the posterior gastric wall. A double nasocystic tube was placed for continuous lavage of the abscess. Pseudomonas aeruginosa was cultured and antibiotics were administered according to sensitivity tests. The clinical status returned gradually to normal. A follow-up CT scan 4 months later showed complete resolution of abscesses.


RESULTS
The drainage of the abscesses was done by the means of endoscopic cystogastrostomy and transpapillary stent insertion. This was a minimally invasive intervention, by which we avoided surgical intervention that bears significant mortality and morbidity.


CONCLUSIONS
Endoscopic drainge of pancreatic abscesses may be the therapy of choice in such patients mainly because it does not prevent the chance of subsequent surgical intervention if needed.
Department of Internal Medicine II, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic. vlastimil.prochazka@fnol.cz
Vlastimil
V
Prochazka
Saaba
S
Al-Eryani
Miroslav
M
Herman
D000038:Abscess / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D016145:Endoscopy, Digestive System; D006801:Humans; D008297:Male; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D011552:Pseudomonas Infections / Q000628:therapy*; D015607:Stents