ANATOMIC ACCESS TO PANCREATIC FLUID COLLECTIONS

In approximately 10% of patients, acute pancreatitis is complicated by formation of acute fluid collections, necrosis, abscess, or pseudocysts.(1) These changes may remain confined to the pancreas or may extend to the lesser sac, the pararenal spaces, the root of the small bowel mesentery, or the transverse mesocolon. Occasionally, inflammatory changes and fluid collections involve more distant sites such as the mediastinum, the pelvis, or subcapsular collections in the spleen or liver. Radiographic imaging by ultrasonography and contrast-enhanced computed tomography has proven to be valuable for detection of complications of acute pancreatitis.(2) Imaging has a significant impact on patient management and facilitates the choice between conservative treatment vs surgical or percutaneous radiological intervention.(3-7) Large simple fluid collections such as chronic pseudocysts are often readily accessible to percutaneous drainage. More commonly, however, patients present with complex, multiloculated fluid collections.(8) Attempts at percutaneous drainage frequently present a technical challenge and require careful planning of a safe access route. The purpose of this article is to illustrate a variety of potential access routes and to discuss their advantages and disadvantages based on our experience with percutaneous drainage procedures in patients with complicated pancreatitis.