Prognosis in Pancreatic Abscess

Pancreatic abscesses are a rare complication that has historically been associated with pancreatitis. Abscesses require surgical intervention, and this study explored prognostic indicators in 36 dogs that were diagnosed with pancreatic abscesses based on discovery of purulent exudates within the parenchyma of the pancreas during exploratory laparotomy. Indications for surgery included a pancreatic mass on ultrasonography, a mass seen on survey radiographs, exploration with or without jejunostomy placement, peritonitis, septic peritonitis, severe cholestasis, gallbladder obstruction, acute abdomen, small intestinal biopsy, and gastric outflow obstruction. Surgical interventions included pancreatic debridement, partial pancreatectomy, pancreatic biopsy, duodenostomy tube placement, jejunostomy tube placement, Sump-Penrose drain placement, and/or an open abdominal drainage technique. Nine dogs required a second abdominal procedure (2 required a second exploration and 7 needed closure of an open abdomen). Six dogs were euthanized at the time of surgery, 8 dogs were euthanized after surgery, and 8 dogs died. Fourteen dogs were discharged alive with follow-up consultations ranging from 2 months to 7 years. Interestingly, the isolation of microbial agents is much less common in dogs than in humans with pancreatic abscesses. In this study, only in 2 patients did culture of the pancreas or pancreatic exudates yield bacterial growth. Peritoneal fluid, however, yielded growth in 7 of 12 cultures. Other noteworthy findings included that biochemical features of pancreatic abscessation, such as changes in bicarbonate and alkaline phosphatase, were statistically significant but direct correlations to clinical outcome were difficult to make. Use of perioperative antibiotics, abdominal drainage techniques, nutritional support, and colloids could not be definitively associated with either poor or improved survivability because of the small sample sizes. The authors did conclude that dogs with pancreatic abscesses were subject to prolonged hospitalization, and that morbidity and mortality rates were high regardless of the treatment regimen.

COMMENTARY: This study provides a good overview of a condition that is rarely reported in dogs. In reality, perhaps a major contributing factor to treating this serious condition (that was not mentioned in this paper) would be the owner's financial commitment. Pancreatic abscess, like severe pancreatitis, requires supportive care and prolonged hospitalization. The study was not able to conclude whether a specific treatment or piece of data would accurately predict survival. Perhaps a follow-up study could include patients from other institutions with a more in-depth comparison of similarly treated cases.

Pancreatic abscess in 36 dogs: A retrospective analysis of prognostic indicators. Anderson JR, Cornell KK, Parnell NK, Salisbury SK. JAAHA 44:171-179, 2008.