[Pancreatic abscess. Extraperitoneal drainage]. / Absceso pancreático, drenaje por vía extraperitoneal.

The pancreatic abscess occurs in two to six per cent of patients with acute pancreatitis and in 40 to 50 per cent of whom develop the severe form of the disease. The postoperative morbidity rate is 85 to 90 per cent and the mortality rate is 30 to 50 per cent due to persistence or recurrence of infection. The anatomical location and dissemination of the pancreatic abscess allows an extraperitoneal approach. Twelve patients with pancreatic abscess are reported. Seven males and five females, with an average age of 36 years. Fever, abdominal pain, cutaneous hypersensitivity and palpable abdominal mass were the most frequent clinical signs. Most of them developed multiple organic failure, leukocytosis, hyperglycemia, increasing L.D.H. and alkaline phosphatase levels. The CAT scan was most useful to localize the abscess. About 83 per cent of patients had been operated on previously. The extraperitoneal surgical approach was anterior in 10 patients and posterior in two patients. Ten patients developed complications that resolved with conservative measures. Two patients (17%) died. Extraperitoneal drainage is a valid alternative to prevent peritoneal contamination and some other serious postoperative complications in the management of pancreatic abscess.

[Lithiasis of hepato-cystic-choledochal confluence. Surgical treatment]. / Litiasis de la encrucijada hepático-cístico coledociana. Tratamiento quirúrgico.

The author reviews the case histories of ten patients who had gallstones at the confluence of the cystic and common bile ducts. These were found within a total group of 1,388 patients operated on at the Hospital La Raza between 1971 and 1973 for biliary tract and gallbladder disease. In all of these cases a reconstruction of the common bile duct over a T catheter and extending to the cystic duct was carried out. The usual technique for cholecystectomy could not be used. The satisfactory results were due to the careful dissection of the area, adequate irrigation of the small cystic duct segment used for the reconstruction and to cholangiographic control carried out during surgery. Even though this type of problem in infrequent (0.7%) among biliary tree digestive tract fistulas, we must keep it in mind because it may bring about iatrogenic lesions of the biliary tree which may be fatal. In this small series there were no deaths and the postoperative evolution was satisfactory.