General Papers 12

Abstract

Aims: A radical shift in management of abdominal sepsis from surgery to radiological drainage occurred in 20 years. This is safe and in majority it avoids the need for conventional surgery. When surgery is indicated it provides the roadmap by showing the exact nature of the abscess and its contents. This is a retrospective study from single centre to look at the outcome of management of localized intra-abdominal sepsis by using radiological guided drainage. Methods: All the patients who underwent radiological intervention for abdominal sepsis between 1995 and 2001 were included in the study. These were scanned and drains were inserted under radiological guidance under local anaesthetic. All these patients were followed up with antibiotics and drainograms when appropriate. Results: These patients were between ages of 14 and 84 years. A total of 216 procedures were performed. Twenty-four of them were diagnostic in that the patients were subjected to laparotomy or conservative management. A total of 192 patients had therapeutic aspiration or drainage. One hundred and forty-five patients had catheters inserted for continuous drainage and the rest had therapeutic aspiration. These patients included pelvic abscess (15 per cent), perinephric collections (12.4 per cent), subdiaphragmatic abscess (12 per cent), liver abscesses (8 per cent), pseudocysts (7 per cent), pericolic abscess (7.5 per cent), sub-hepatic abscess (5 per cent), psoas abscess (3.4 per cent), appendicular abscess (3.4 per cent), empyema gall bladder and pancreatic abscesses. Complications were minimal including transient sepsis, residual collection, haemorrhage into the cavity and persistent sinus. Our results include bacteriological studies of aspirates, which will be presented in detail at the time of presentation. Conclusion: Percutaneuos guided aspiration and drainage is a safe and effective alternative to conventional open surgical drainage. We recommend this as the first line of management.