Infected Necrosis and Pancreatic Abscess

Infected necrosis (IN) and pancreatic abscess (PA) are septic complications of acute pancreatitis (AP), and are characterised by a severe prognosis and high mortality rates (20–40%). The overall incidence is 3–8% and can reach 60% in cases of acute necrotizing pancreatitis. In our experience, the overall incidence was 7,1% for IN and 6,7% for AP, with mortality rates of 30 and 14,8%, respectively. Bacterial superinfection is generally caused by enteric Gram-negative germs that reach the pancreas by translocation through the gut and the colon. These conditions produce a very bad prognosis, and require both adequate medical and intensive care as well as surgical treatment, which must be provided as early as possible. In AP, the treatment is based on surgical or, in selected cases, radiological drainage of pus. For IN, the surgical treatment is based on necrosectomy, debridement and removal of infected tissue, by using either a closed procedure and continuous postoperative lavage, or by means of laparostomy (open treatment). In this paper, we shall consider the complex diagnostic tests required in these conditions, as well as the advantages and disadvantages of different surgical procedures. Our series of 29 surgical cases of infected acute pancreatitis will also be presented.