Management of Abdominal and Pelvic Abscesses That Persist Despite Satisfactory Percutaneous Drainage Catheter Placement

Abstract

The purposes of this study were to determine the frequency with which percutaneous abdominopelvic abscess drainage catheters must be replaced because of inadequate drainage, to assess the effect of percutaneous catheter exchange on clinical outcome, and to determine the predictors of clinical success after catheter exchange. A database of interventional radiology procedures performed at a single tertiary care hospital from 2001 to 2006 was searched to identify the cases of patients who underwent percutaneous catheter drainage of abdominal or pelvic abscesses that was followed by exchange of the drainage catheter at a later date. The electronic medical records and imaging studies of these patients were retrospectively reviewed to determine the abscess characteristics, details of drainage catheter manipulation, and clinical outcome. Among the 3,027 percutaneous abscess drainage catheters placed, 82 were exchanged because of lack of improvement (imaging evidence of undrained fluid and persistent fever and leukocytosis), for an overall frequency of catheter exchange of 2.7% of abscesses in 3.7% of patients. The success rate of catheter replacement, defined as resolution of the fluid collection without open surgical drainage, was 76.8% (63/82). Prognostic factors favorably influencing the clinical success of catheter exchange included a larger number of drainage catheter sideholes, absence of a fistula, low residual abscess volume after initial catheter drainage, and low CT attenuation of abscess fluid. In cases of persistent abscess despite adequate catheter placement, percutaneous catheter exchange over a wire is useful for salvage after the large majority of primary failures. In addition, performance of CT and fluoroscopic catheter injection before catheter exchange facilitates recognition of the predictors of a likely response to catheter exchange.