Percutaneous catheter drainage of pancreatic and peripancreatic necrotic collections: a review

Acute pancreatitis is a frequent cause of abdominal pain requiring hospital admission. Most cases have a benign course and do not need aggressive treatment. Severe acute necrotizing pancreatitis is uncommon but carries high rates of in-hospital mortality and morbidity, and these patients usually need intensive care and prolonged hospital stay. During the past two decades the treatment of acute necrotizing pancreatitis has evolved from open surgery to minimally invasive techniques. International guidelines currently recommend endoscopic or percutaneous drainage as first-line treatment for pancreatic and peripancreatic necrosis, but there is still no global consensus on optimal clinical indications, technique, and timing of treatment. Early drainage of sterile collections in symptomatic patients and use of multiple, large bore catheters with a proactive management might be effective strategies in reducing the need for surgical necrosectomy and improving patients’ outcome. However, further, more conclusive studies are needed. Severe acute pancreatitis is a complex disease with systemic involvement requiring a multidisciplinary approach; in this setting, the radiologist now plays an important role not only in the characterization and follow-up of this condition and its complications, but also in its active management. The purpose of this review was to provide an overview of clinical features and imaging findings of acute necrotizing pancreatitis, and to summarize the current literature and research developments about percutaneous image-guided drainage of necrotic collections.