Diagnosis of pancreatic abscess via percutaneous aspiration

The pre-operative diagnosis of a pancreatic abscess was not considered in a comprehensive review in 1972. However, advances in technology (Ultrasound-US, Computed Tomography-CT) has allowed guided percutaneous needle aspiration (PNA) of suspected pancreatic lesions. The purpose of this study was to evaluate the safety and diagnostic ability of PNA to differentiate acute pancreatic inflammatory masses from pancreatic abscess (PA). Thirteen patients underwent PNA after US or CT revealed an acute pancreatic inflammatory mass (12/13 cystic). One patient underwent a second aspiration. Clinical features T°-101.3°F mean (13/13), leukocytosis 14,400 cu/mm (11/13). Aspirated material was gram-stained and examined for bacteria and leukocytes and cultured. Results: PNA was accomplished successfully in all patients. Aspirate revealed bacteria in nine and pancreatic abscess was confirmed at surgery (8) or post-mortem exam (1). Four of five patients in whom no bacteria were visualized had medical resolution, the fifth had continued T° and underwent a second aspiration which diagnosed a PA. PA contained moderate to large number of PML via aspiration. Conclusions: PNA provides a potentially important and safe diagnostic adjunct to earlier accurate differential diagnosis of pancreatic inflammatory masses from pancreatic abscess.