Spontaneous drainage of pancreatic abscess into digestive tract

1 Klinika Chorób Wewnętrznych, 5. Wojskowy Szpital Kliniczny w Krakowie. Kierownik Kliniki: dr hab. n. med. Iwon Grys, prof. nadzw.
2 Klinika Gastroenterologii, Wojskowy Instytut Medyczny w Warszawie. Kierownik Kliniki: prof. dr hab. n. med. Jerzy Gil
Adres do korespondencji: Andrzej Hebzda, Klinika Chorób Wewnętrznych, 5. Wojskowy Szpital Kliniczny, ul. Wrocławska 1–3,
30-901 Kraków, tel.: 12 630 82 21, faks: 12 630 82 24, e-mail: andrzejhebzda@o2.pl
Praca finansowana ze środków własnych

Pediatr Med rodz Vol 10 Numer 1, p. 67–70
DOI: 10.15557/PiMR.2014.0010
ABSTRACT

The progress of the modern graphic technology is connected with better diagnosing of the pseudocyst of the pancreas in clinical practice. The pancreas pseudocysts are diagnosed accidentally in 20% of the patients in ultrasound examination, computed tomography, magnetic resonance imaging or endosonography; 24% of the patients reveal such abnormality in autopsy examinations. Pseudocyst is a complication occurring in 7–15% of acute pancreatitis patients. Usually they dissolve spontaneously, however, pseudocysts of diameter higher than 6 cm have a 30–50% risk of complications such as: rupture, bleeding and infection. Pseudocyst can turn in abscess in few weeks since acute pancreatitis. In this article we would like to present a case of spontaneous drainage of pancreatic abscess into gastric lumen. The treatment options for this entity are dictated by the severity of symptoms, the size of the pseudocyst, the ductal anatomy, and the surgical expertise available. Surgical drainage using open laparotomy or percutaneous drainage were the chosen treatment options. In most of the cases open surgical drainage should be reserved for patients in whom pancreatic necrosis, abscess, haemorrhage, or rupture of pseudocyst occurs. Transmural drainage using approach endoscopic ultrasound guidance is a technically feasible, minimally invasive, and safe procedure for drainage of pancreatic pseudocyst.

Keywords: spontaneous drainage, pancreatic abscess, fistula, endoscopy, computed tomography