The Treatment Of Infected Pancreatic Pseudocyst In Severe Acute Pancreatitis

Objective:To investigate diagnostic and therapeutic methods of infection of pancreatic pseudocyst in severe acute pancreatitis.Methods:The clinical data of 207 patients with severe acute pancreatitis were analyzed retrospectively and related literatures were disccused.Results:41patients complicated pseudocyst in 207 patients with severe acute pancteatitis,and 19 patients experienced endoscopic transmural drainage,percutaneous catheter drainage,or open surgery.11 received percutaneous catheter drainage under sonographic guidance,6 received surgery,1 patient received EUS-guided drainage followed transpapillary stenting in pancreatic duct,and 1 patient received percutaneous catheter drainage under sonographic guidance followed EUS-guided drainage.We cultivated each drainage,and got 9 possitive results(22%).The 10 patients,including 4 males and 6 females,who had a high fever(T＞39℃) and were unresponsive to antibiotic,received cultivation of drainage and blood.4 were positive in blood cultivation,1 Candida tropicalis,1 Baumanii,1 Enterococcus faecalis,and 1 Staphylococcus epidermidis.And in drainage cultivation,3 were Escherichia coli (ESBL+),2 were Enterococcus faecalis,1 was Staphylococcus epidermidis(MRSE),2 were Baumanii,1 were Candida tropicalis,3 were Staphylococcus haemolyticus,and 2 patients had mixed infections,1 patient's cultivation got negative results both in drainage and blood.The cultivation of drainage and blood was same in only 2 patients. Prognosis:10 patients whose cultivation was negative were improved,among 9 infected patients,4 were improved,1 died of MODS,4 gave up therapy because of MODS.The morbility of pancreatic pseudocysts secondary to severe acute pancreatitis is 14.6%.Conclusion:Pancreatic pseudocysts are a well-known complication of severe acute pancreatitis,with a higher incidence in the latter,and once infection take place,the mortality and morbidity is much high.And so,drainage of pseudocysts should be enforced actively and promptly.If the wall are immature,ultrasound-guided percutaneous drainage is a good choice.