Development of a pancreatic abscess is an infrequent but serious complication of pancreatitis in dogs. Death has been reported in 4 of 9,a 3 of 6,1 and 6 of 72 affected dogs. In previous reports1,2,a of pancreatic abscesses in dogs, treatment via closed and open peritoneal drainage for suspected septic peritonitis has been described. Nevertheless, most pancreatic abscesses in dogs yield negative results of bacteriologic cultures1,2,a and are generally thought to be sterile abscesses or pancreatic phlegmons,2,3 and it may not be necessary to subject dogs to the potentially serious complications and additional surgical procedures associated with open peritoneal drainage.
The ability to physically drain the abdomen during septic peritonitis is challenging; however, development of open peritoneal drainage and advances in materials for use with closed abdominal drainage have improved treatment for peritonitis.4 A pancreatic abscess represents a serious localized aseptic peritonitis. Localized peritonitis of various causes has been effectively treated via repair of the primary insult, lavage, debridement, omentalization, and abdominal closure with or without external abdominal drainage.4–14 Omentalization represents an effective physiologic drain.
Open peritoneal drainage is indicated in selected cases of generalized septic peritonitis.15–20 This technique is thought to allow excellent drainage of the infected abdominal cavity and to increase oxygen tension to the detriment of anaerobic bacteria.14–18,b Open peritoneal drainage has been associated with high morbidity and mortality rates and has been reported5,14 to have no advantage over closed abdominal procedures. Open peritoneal drainage also has reported14–18,b complications of hypoalbuminemia, hypoproteinemia, anemia, and nosocomial infections.
The omentum has several features that are advantageous in treatment for pancreatic abscesses. The omentum provides increased blood flow and induces and promotes angiogenesis.13,14 The omentum also contains lymphoid and myeloid cells for increased immune cell delivery. Additionally, macrophages in the omentum stimulate fibroblast function and proliferation, which aid and control wound healing.13 The omentum also provides effective drainage for exudates and effusions.7–12,19–23
Clinical use of the omentum has been reported in the surgical management of many intra-abdominal6–12,24–27 and extra-abdominal conditions.19–23,28–30 To the authors’ knowledge, omentalization has not been described for treatment of dogs with pancreatic abscesses, although the concept of omentalization of intra-abdominal abscesses has been promoted14 and omentalization has been used successfully in treatment of dogs with pancreatic pseudocysts.24,25
The purpose of this retrospective study was to evaluate the hypothesis that dogs with pancreatic abscesses treated with omentalization and abdominal closure are more likely to survive, have shorter hospital stays, and have fewer complications than dogs with pancreatic abscesses treated with open peritoneal drainage. Preoperative findings as part of a PSS were evaluated for an association with outcome.
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Pancreatitis severity score