title: Strategy for effective percutaneous drainage of pancreatic collections: results on 121 patients.
abstract: There is a lack of technical guidelines for image-guided percutaneous drainage (IGPD) of pancreatic fluid collections (PFCs). To fill that void, we present a strategy and guidelines for systematic IGPD for effective PFCs evacuation.
  
  
  METHODS
  Institutional Review Board (IRB)-approved study of 121 pancreatitis patients with symptomatic PFCs that underwent IGPD. IGPD strategy aimed at evacuation of the PFCs compartments using vigorous catheter drainage and manipulations. PFCs resolution and patients' outcome were measured.
  
  
  RESULTS
  Pancreatitis pathogenesis and etiology included: necrotizing, 79 patients (alcoholic, 40; biliary, 20; hyperlipidemia, 8; other, 11); traumatic, 32 patients; and chronic ductal, 10 patients (pseudocysts). An ipsilateral retroperitoneal access was used for pararenal spaces PFCs (61, 50% patients), a transabdominal IGPD approach for anterior PFCs (49 patients, 41%), an intercostal/subcostal access for left subphrenic PFCs (22 patients, 18%), and a transgastric drainage route for retrogastric PFCs (9 patients, 7%). Table 1 lists the site of the pancreatic fluid collections and number and size of the catheter(s) used for IGPD of the PFCs in the 121 patients. Fifty-seven (47%) patients had positive cultures PFCs. Of these, 24 (20%) had polymicrobial infections, and 18 (15%) had fungal infections. There were 20 (11%) patients with multi-compartment drainage. PFCs resolution occurred in 102 (84%) patients. PFCs recurrence was treated by surgery (four patients) or IGPD (one patient). Pancreatic fistulas closed, except in one patient. Nine patients (7%) experienced multiorgan failure/death; 5 (4%) were lost to follow-up.
authors.affiliation: Department of Radiology and Surgery, Louisiana State University Health Sciences Center, Shreveport, USA.
authors.forename: Horacio B
authors.initials: HB
authors.lastname: D'Agostino
authors.forename: Alireza
authors.initials: A
authors.lastname: Hamidian Jahromi
authors.forename: Elnaz
authors.initials: E
authors.lastname: Jafarimehr
authors.forename: Patrick
authors.initials: P
authors.lastname: Johnson
authors.forename: Daniel
authors.initials: D
authors.lastname: Do
authors.forename: Benjamin
authors.initials: B
authors.lastname: Henderson
authors.forename: Quyen
authors.initials: Q
authors.lastname: Chu
authors.forename: Hosein
authors.initials: H
authors.lastname: Shokouh-Amiri
authors.forename: Gazi
authors.initials: G
authors.lastname: Zibari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D013813:Therapy, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional