GI Radiology > Pancreas > Inflammatory > Abscess

Pancreatic Abscess

A pancreatic abscess is an intra-abdominal collection of pus near the pancreas, and contains little or no necrosis. Pancreatic abscess usually begin to form within 7-14 days after an episode of acute pancreatitis, but they may present much later. Approximately 2-6% of patients with acute pancreatitis develop a pancreatic abscess. Abscesses may be suspected in patients with spiking fever. In suspected cases, US and CT are indicated for diagnosis and percutaneous drainage. In cases of failed percutaneous drainage, surgical intervention is indicated.

Radiologic findings of an abscess include a low density center, rim of enhancement, and possible gas bubbles (more specific). The table below compares US versus CT in the diagnosis of abscesses. Diagnosis may be confirmed by radiographic-guided aspiration.

Comparison of US versus CT in Abscess Diagnosis

-May be done at bedside
-Most effective in RUQ, peridiaphragmatic
-Gas may limit exam of mid abdomen
-Unable to definitely R/O abscess
-Gives all encompassing image
-Not affected by bowel gas
-Clearly identifies bowel for access route planning

Catheter Management:

Following appropriate diagnosis, and radiologic and surgical consultation, CT guided needle aspiration may be performed. In cases of abscesses that yield pus, a catheter may be placed to drain the purulent fluid. The cathater is placed on suction (connected to a Jackson-Pratt bulb), and should be irrigated with saline each shift. Patient's temperature, WBC, and drainage volume are monitored. A decrease in temperature should be expected in 24-48 hours; the WBC count should decrease within a week. The catheter may be pulled upon resolution of symptoms, normalization of vitals/WBC, decrease of abscess cavity size (as measured by repeat CT/US), and cessation of drainage. Percutaneous drainage (PCD) is effective in 40% of patients as the sole method of treatment. Studies have shown PCD of abscesses to be more effective than surgical methods, with lower mortality, complications, and recurrence.

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