Infectious complications account for 80 per cent of the deaths resulting from acute pancreatitis. Future progress in the mortality of severe acute pancreatitis requires that we turn our attention toward the management of secondary pancreatic infections--abscess, infected pseudocyst and IPN. Review of 1,100 reported instances of secondary pancreatic infections reveals a pressing need for precise definitions of the individual infectious complication. In view of the marked discrepancy in definitions of disease between previous investigators, prior data must be seriously questioned, and doubt is cast upon long-standing recommendations for treatment. Recent advances in knowledge of the physiopathologic nature and diagnosis of secondary pancreatic infections promise improved surgical results. In particular, current diagnostic methods offer opportunities for more timely surgical intervention, avoiding the excessive mortality rate attendant upon delayed recognition. Furthermore, the use of condition-specific procedures, such as transcutaneous drainage for infected pseudocysts, débridement and sump drainage for pancreatic abscess and open drainage for IPN, may prove useful in combating the excessive morbidity and mortality rates caused by these conditions.
