Third day after admission. By the eighth hospital day, the patient is noted to have recurrent fever 101°F, progressive leukocytosis 18,500 WBC/mm3, and tachypnea. The most appropriate management includes which as the next step?
A. Laparotomy with pancreatic debridement B. CT guided aspiration of peripancreatic fluid collections
C. ERCP with sphincterotomy and placement of hi!iary stent
D. Intravenous amphotericin B
Ans. B. CT guided aspiration of peripancreatic fluid collections
The
common causes of pancreatic abscesses are infected pancreatic pseudocysts and
necrotizing pancreatitis. The diagnosis is suggested by persistent fever,
leukocytosis, and a palpable abdominal mass. Bacteremia and systemic toxicity
are late clinical features. Percutaneous aspiration with positive cultures is
the definitive preoperative test, facilitated by CT scanning or
ultrasound-guidance to suspicious pen- pancreatic fluid collections. When
diagnosed, the treatment of choice is wide surgical débnidement with removal of
all infected and revitalized tissues. Generous drainage is mandatory. One of
the major sources of morbidity and mortality in this situation is the late
development of mycotic visceral pseudoaneurysms, particularly involving the splenic
circulation. These may be complex management problems, requiring angiographic
embolization or other innovative treatment strategies.
