The decision to operate a patient with large fluid collection is often based on clinical signs of inflammation regardless of the acute bacteriological status of collection and necrosis. Fluid collections associated with alcoholic and biliary pancreatitis usually require surgical mode of treatment. A better definition of fluid collections, improvement in imaging studies and expertise in interventional radiology are a major deciding factors in choice of treatment of fluid collections. Percutaneous drainage is safe and effective and should be the treatment of first choice in poor risk patient with small collections. In event of fluid collection associated with necrosis percutaneous drainage followed by laparoscopic evacuation of necrotic debris is possible.
Surgical treatment is the backup management in the event that percutaneous treatment fails.
Patients who ultimately require surgery are more stable after 7-10 days of catheter drainage and are most likely to require only one operation, as during the drainage period the infections coalesce which facilitates surgical debridement of necrotic material. Early diagnosis, clinical vigilance in detecting complications, referral of patients to specialized centres before they become morbid, ensures state of art multidisciplinary management and hastens outcome in acute pancreatitis. A clinical based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis Atlanta. Pitchumoni CS, Agarwal N. Pancreatic pseudocysts.