Abstract
The clinical records of surgical treatments for severe acute pancreatitis were reviewed in the National Survey of Acute Pancreatitis in 2003. Among 549 cases with severe acute pancreatitis, 62 cases were treated surgically. Necrosectomy was performed in 25 cases (35%), and 8 cases had fatal outcomes. Among 25 cases with necrosectomy, the preoperative diagnosis was pancreatic abscess in 7 cases. On the other hand, the mortality rate of the 43 cases which were diagnosed as pancreatic abscess was as high as 23%, being comparable to the mortality of cases whose diagnoses were infected pancreatic necrosis. Moreover, among thirty-one cases initially treated with percutaneous abscess drainage, surgical drainage and necrosectomy were necessary in 7 and 4 cases, respectively. Four of the 20 cases (20%) treated only with percutaneous drainage without operation died. These results strongly suggest that infected pancreatic necrosis is misdiagnosed as pancreatic abscess in a considerable number of cases. We should note that infected pancreatic necrosis is sometimes obscured under the diagnosis of pancreatic abscess, and that surgery should be selected without hesitation when percutaneous drainage is not effective for pancreatic abscess.
