Abstract No. 61: Intrathoracic complications following percutaneous intercostal drainage of abdominal fluid collections

Abstract

PurposePercutaneous catheter drainage performed to evacuate abdominal fluid collections often necessitates an intercostal approach and thus transgression of the pleural space. Reported complications from this approach include pleural effusions, pneumothorax, or empyema, though no large series has been published. The purpose of our study is to examine all intrathoracic complications following intercostal abdominal drainage procedures.Materials and MethodsWe retrospectively reviewed medical records and imaging from image guided percutaneous catheter drainage procedures for intra-abdominal fluid collections. Only procedures requiring an intercostal approach without pre-existing transpleural drainage catheters in place were included, while percutaneous biliary or cholecystostomy drainage catheters were excluded. Intrathoracic complications that developed immediately following catheter insertion or revealed on subsequent imaging, laboratory, or procedures were recorded and categorized. Catheter type and duration, intercostal space transgressed, and intrathoracic findings at the time of drainage were also studied.ResultsIntercostal drainage procedures meeting criteria were performed on 27 patients (29 drains) for 11 perihepatic, 7 peripancreatic, 4 intrahepatic, 2 perisplenic, 2 perigastric, and 1 perirenal fluid collection. The mean indwelling catheter time was 35 days (range 1-184 days). Six drains transgressed the ribs 7-8, 3 through ribs 8-9, and 1 through ribs 9-10. There were 5 major complications, including 3 subsequent pigtail thoracostomies, one nerve ablation and one video assisted thorascopic procedure for empyema. We discovered 6 minor complications: 2 increased pleural effusions, 2 intrapleural contrast extravasations, 1 drain-associated pain, and 1 inadvertent tube loss.ConclusionWe demonstrated that percutaneous drainage from an intercostal approach resulted in significant number of major intrathoracic complications including requirement for secondary interventions. The majority of complications occurred after catheter insertion above the 9th intercostal space. PurposePercutaneous catheter drainage performed to evacuate abdominal fluid collections often necessitates an intercostal approach and thus transgression of the pleural space. Reported complications from this approach include pleural effusions, pneumothorax, or empyema, though no large series has been published. The purpose of our study is to examine all intrathoracic complications following intercostal abdominal drainage procedures. Percutaneous catheter drainage performed to evacuate abdominal fluid collections often necessitates an intercostal approach and thus transgression of the pleural space. Reported complications from this approach include pleural effusions, pneumothorax, or empyema, though no large series has been published. The purpose of our study is to examine all intrathoracic complications following intercostal abdominal drainage procedures. Materials and MethodsWe retrospectively reviewed medical records and imaging from image guided percutaneous catheter drainage procedures for intra-abdominal fluid collections. Only procedures requiring an intercostal approach without pre-existing transpleural drainage catheters in place were included, while percutaneous biliary or cholecystostomy drainage catheters were excluded. Intrathoracic complications that developed immediately following catheter insertion or revealed on subsequent imaging, laboratory, or procedures were recorded and categorized. Catheter type and duration, intercostal space transgressed, and intrathoracic findings at the time of drainage were also studied. We retrospectively reviewed medical records and imaging from image guided percutaneous catheter drainage procedures for intra-abdominal fluid collections. Only procedures requiring an intercostal approach without pre-existing transpleural drainage catheters in place were included, while percutaneous biliary or cholecystostomy drainage catheters were excluded. Intrathoracic complications that developed immediately following catheter insertion or revealed on subsequent imaging, laboratory, or procedures were recorded and categorized. Catheter type and duration, intercostal space transgressed, and intrathoracic findings at the time of drainage were also studied. ResultsIntercostal drainage procedures meeting criteria were performed on 27 patients (29 drains) for 11 perihepatic, 7 peripancreatic, 4 intrahepatic, 2 perisplenic, 2 perigastric, and 1 perirenal fluid collection. The mean indwelling catheter time was 35 days (range 1-184 days). Six drains transgressed the ribs 7-8, 3 through ribs 8-9, and 1 through ribs 9-10. There were 5 major complications, including 3 subsequent pigtail thoracostomies, one nerve ablation and one video assisted thorascopic procedure for empyema. We discovered 6 minor complications: 2 increased pleural effusions, 2 intrapleural contrast extravasations, 1 drain-associated pain, and 1 inadvertent tube loss. Intercostal drainage procedures meeting criteria were performed on 27 patients (29 drains) for 11 perihepatic, 7 peripancreatic, 4 intrahepatic, 2 perisplenic, 2 perigastric, and 1 perirenal fluid collection. The mean indwelling catheter time was 35 days (range 1-184 days). Six drains transgressed the ribs 7-8, 3 through ribs 8-9, and 1 through ribs 9-10. There were 5 major complications, including 3 subsequent pigtail thoracostomies, one nerve ablation and one video assisted thorascopic procedure for empyema. We discovered 6 minor complications: 2 increased pleural effusions, 2 intrapleural contrast extravasations, 1 drain-associated pain, and 1 inadvertent tube loss. ConclusionWe demonstrated that percutaneous drainage from an intercostal approach resulted in significant number of major intrathoracic complications including requirement for secondary interventions. The majority of complications occurred after catheter insertion above the 9th intercostal space. We demonstrated that percutaneous drainage from an intercostal approach resulted in significant number of major intrathoracic complications including requirement for secondary interventions. The majority of complications occurred after catheter insertion above the 9th intercostal space.