Document Detail


Natural orifice translumenal endoscopic drainage for pancreatic abscesses.
MedLine Citation:
PMID:  18855067     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Few series describe endoscopic drainage of pancreatic abscesses. Abscesses are complications of pancreatitis, presenting with sepsis, peritonitis, or both. This report describes the feasibility and efficacy of natural orifice translumenal endoscopic surgery for pancreatic abscesses. METHODS: This study reviewed 35 consecutively treated patients for the period 1994-2007. The approaches alone or in combination were transmural (transgastric or transduodenal) and transpapillary. The criteria for abscesses were two or more of the following: fever, abdominal pain, elevated white blood count (WBC), and positive fluid cultures. RESULTS: The 35 patients (19 men and 16 women) had a mean age of 49 years. The abscesses had idiopathic (37%), gallstone (32%), alcohol (20%), and divisum (11%) etiologies. The presenting signs were abdominal pain (80%), positive cultures (69%), fever (57%), elevated WBC (51%), and nausea/vomiting (39%). The approaches for abscess drainage were as follows: transgastric (n = 15, 43%), transduodenal (n = 4, 11%), transgastric combined with transpapillary (n = 8, 23%), transduodenal combined with transpapillary (n = 1, 3%), and transpapillary alone (n = 7, 20%). A total of 28 patients (80%) achieved successful endoscopic pancreatic abscess drainage, whereas 7 (20%) required surgery. Of these seven patients, two (6%) required emergent laparotomy to control bleeding, and the remaining five (14%) were explored after failure to demonstrate clinical improvement from endoscopic drainage. Three patients required internal drainage, and two patients required distal pancreatectomy. The mean follow-up period was 15 months, and the complication rate was 6%. No one died from the procedure. CONCLUSION: Endoscopic surgery for pancreatic abscess is feasible and effective. It is an alternative to surgery that currently can be considered a primary treatment option for selected pancreatic abscesses.
Authors:
Gary C Vitale; Brian R Davis; Michael Vitale; Tin C Tran; Robert Clemons
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Publication Detail:
Type:  Journal Article     Date:  2008-10-15
Journal Detail:
Title:  Surgical endoscopy     Volume:  23     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-30     Completed Date:  2009-04-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  140-6     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Louisville, Louisville, KY 40292, USA, garyvitale@gmail.com.
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MeSH Terms
Descriptor/Qualifier:
Abscess / complications,  diagnosis,  surgery*
Adolescent
Adult
Aged
Aged, 80 and over
Cohort Studies
Drainage*
Endoscopy*
Feasibility Studies
Female
Humans
Male
Middle Aged
Pancreatic Pseudocyst / microbiology,  pathology,  surgery*
Pancreatitis / microbiology,  pathology,  surgery*
Retrospective Studies
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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