Pseudocyst drainage predisposes to infection when pancreatic necrosis is unrecognized.

The objective of this report was to determine the clinical outcome of intervention among patients with a pancreatic pseudocyst associated with sterile pancreatic necrosis. We reviewed records of all patients with sterile pancreatic necrosis who required intervention during the past 10 yr. A total of 17 patients required intervention. Twelve with sterile necrosis unassociated with a pancreatic pseudocyst underwent surgical debridement. An additional five patients with sterile necrosis associated with a pancreatic pseudocyst underwent drainage of the pseudocyst (two by pigtail catheter drainage, one by endoscopic cyst gastrostomy, and two by surgical cyst gastrostomy). After drainage, four of these five patients developed pancreatic infection that required surgical debridement. Pancreatic infection occurred because the drainage procedures in these four patients failed to remove the underlying necrotic material. When a pancreatic pseudocyst occurs in association with pancreatic necrosis, radiological and endoscopic decompression should not be attempted.