Catheter Drainage Research Articles

Efficacy of Tract Embolization on Reducing Pneumothorax in CT-Guided Transthoracic Lung Biopsies: Comparison of Saline and Autologous Blood Patch.

This study aimed to evaluate the effectiveness of two techniques "autologous blood patch (ABP) and saline sealing"in preventing pneumothorax during CT-guided percutaneous transthoracic lung biopsies (PTTLB). We analyzed 218 PTTLB procedures performed on 202 patients, categorizing them into three groups: those receiving ABP, those receiving saline, and a control group with no intervention. We assessed pneumothorax and catheter drainage rates and analyzed potential risk factors, including demographics, procedural positioning, pleura-skin distance, lesion characteristics, and emphysema scores. The overall pneumothorax rate was 25.9%, with 4.3% requiring chest tube insertion. Pneumothorax rates were significantly lower in the ABP (20.3%) and saline groups (17.6%) compared to the control group (44.2%). Catheter drainage rates were 2.7% for saline, 3.4% for ABP, and 7.7% for the control group, with no significant differences (p>0.05). A needle tract thickness of ≥12 mm following injection was identified as a protective factor against pneumothorax (p=0.003). Both autologous blood patch and saline injections into the needle tract are effective strategies for reducing the incidence of pneumothorax during lung biopsies performed with a coaxial system. We propose that saline can be safely used as an alternative to autologous blood patch due to the latter's disadvantages, including the requirement for blood collection from the patient and pre-procedural preparation, while the saline technique offers the advantage of easier application with similar efficacy.

Ultrasound-Guided Percutaneous Catheter Drainage in Periappendiceal abscess Management: Retrospective Insights

Ultrasound-Guided Percutaneous Catheter Drainage in Periappendiceal abscess Management: Retrospective Insights

A standardised comparison of chest and percutaneous drainage catheters to evaluate the applicability of the ‘French’ sizing units

A variety of medical specialities undertake percutaneous drainage but understanding of device performance outside radiology is often limited. Furthermore, the current catheter sizing using the “French” measurement of outer diameter is unhelpful; it does not reflect the internal diameter and gives no information on flow rate. To illustrate this and to improve catheter selection, notably for chest drainage, we assessed the variation of drain performance under standardised conditions. Internal diameter and flow rates of 6Fr.-12Fr. drainage catheters from 8 manufacturers were tested to ISO 10555-1 standard: Internal diameters were measured with Meyer calibrated pin-gauges. Flow rates were calculated over a period of 30s after achieving steady state. Evaluation demonstrated a wide range of internal diameters for the 6Fr., 8Fr., 10Fr. and 12Fr. catheters. Mean measurements were 1.49 mm (SD:0.07), 1.90 mm (SD:0.10), 2.43 mm (SD:0.11) and 2.64 mm (SD:0.03) respectively. Mean flow rates were 128 mL/min (SD:37.6), 207 mL/min (SD: 55.1), 291 mL/min (SD:36.7) and 303 mL/min (SD:20.2) respectively. There was such variance that there was overlap between catheters of different size: thin-walled 10Fr. drains performed better than 12Fr. “Seldinger” chest drains. Better understanding of drain characteristics and better declaration of performance data by manufacturers are required to allow optimum drain choice for individual patients and optimum outcomes.

Falciform Ligament Abscess Causing Acute Abdomen: Unveiling the Enigma with Review of Literature

ABSTRACT Introduction: Falciform ligament abscess (FLA) is a rare type of intra-abdominal abscess which has been sporadically reported. Diagnosis of FLA can be challenging without typical image findings of an abscess. This study publishes the varied clinical presentations, radiological findings, and management of FLA. Materials and Methods: All patients who were diagnosed and operated for FLA between May 2022 and May 2024 are included in the study. Relevant investigations were done preoperatively. Results: A total of six patients were operated for FLA. The mean age of presentation was 30 days. There were no major perioperative complications in five patients. One patient had pyopericardium which required pericardiocentesis and catheter drainage preoperatively. Conclusion: FLA should be considered in children, especially in infants with vague abdominal symptoms and failure to respond to conservative management. Due to its obscure location, it often causes delay in diagnosis and inadequate treatment. Hence, early consideration of this pathology is crucial for timely diagnosis, proper surgical treatment, and decreased morbidity and mortality.

Rapid Pleurodesis in Patients With Chronic Noninfectious Pleural Effusion: Twenty Years of Real-world Performance Data.

Small cohort studies have shown rapid pleurodesis protocol's (RPP) effectiveness and capacity to expedite pleurodesis for malignant pleural effusion (MPE). This study intends to evaluate the effectiveness of the RPP in inducing pleurodesis in patients with pleural effusions from either malignant or benign etiologies. In this single-center, retrospective cohort study spanning 2 decades, we assessed patients with recurrent symptomatic chronic noninfectious pleural effusion, both benign and malignant. Post-RPP, chest tubes were removed when fluid output dropped below 150mL/d, and patients were discharged with daily indwelling pleural catheter (IPC) drainage. Exclusion criteria included nonexpandable lung and active pleural infection. Treatment success was defined as IPC removal on reduced output (<50mL) on 3 consecutive drainages and radiologic effusion resolution. Recurrence was defined as the occurrence of pleural effusion requiring additional pleural procedures postsuccess. Duration outcome was expressed as median with IPC placement as time zero. Of the 210 patients studied, 72% had MPE, and 28% had benign effusions. The median hospital stay was 4 days post-RPP. Treatment was successful in 177 (84%) patients within a median of 12 days, with no significant differences between MPE and benign cases. Nine patients (5%) experienced recurrence within a median of 152 days. Complications included hemothorax in 4 (1.9%) and empyema in 2 (1%). The thirty-day mortality rate was 9%, with a median survival time of 245 days postprocedure. The RPP combines the benefit of chemical pleurodesis and IPC and appears to be a reasonable option for patients with recurrent and symptomatic pleural effusion.

A Case Report of Contrasting Pre- and Post-Emergency Percutaneous Catheter Drainage CT Images in Patients Having Trauma with Severe Abdominal Compartment Syndrome: A Valuable Tool for Identifying Hemorrhage Sources

A Case Report of Contrasting Pre- and Post-Emergency Percutaneous Catheter Drainage CT Images in Patients Having Trauma with Severe Abdominal Compartment Syndrome: A Valuable Tool for Identifying Hemorrhage Sources

Management of pancreatic fluid collections: A concise review

Abstract A pancreatic fluid collection (PFC) is a local complication of acute pancreatitis. Most PFCs spontaneously resolve and only a minor group of patients need therapeutic intervention. When conservative treatment fails, patients with symptomatic or infected PFCs undergo drainage, either with or without necrosectomy. Three drainage techniques, i.e., endoscopic, percutaneous, and minimally invasive surgery (MIS), are complementary to achieve the symptomatic resolution of the PFC. Endoscopic drainage (ED) with a high technical and clinical success rate has become the current standard of care for mature PFCs. Among the ED techniques, endoscopic ultrasound-guided transmural drainage (EUS-TD) is preferred over conventional transmural drainage for pancreatic pseudocysts or walled-off necrosis (WON). For PFC that is not encapsulated and &lt;4 weeks old, percutaneous catheter drainage ± sinus tract endoscopy works well and is lifesaving in people with abdominal compartment syndrome. Pancreatic necrosectomy is an adjunctive procedure in patients who fail to improve after initial transmural or percutaneous drainage. MIS plays a role if the PFC shows inadequate response to combined drainage and debridement procedures, with open necrosectomy the last resort. Infected pancreatic necrosis is the most dreaded complication of acute necrotizing pancreatitis with a significantly high mortality rate (20%–30%). The “step-up” approach is recommended for infected as well as symptomatic WON. The “surgical step-up” and the “endoscopic step-up” are preferred for infected acute necrotic collection and infected WON, respectively. Various adjunctive methods such as stopping proton-pump inhibitors, hydrogen peroxide irrigation, and nasocystic catheter irrigation help in the earlier resolution of WON by reducing the number of sessions of direct endoscopic necrosectomy (DEN). Using lumen-apposing metal stents for EUS-guided drainage of PFCs has revolutionized the technique with more effective drainage and provides a conduit for DEN.

Efficiency of laparoscopic retroperitoneal pancreatic necrosectomy for treating infected pancreatic necrosis with duodenal fistula: a single-center retrospective cohort study

BackgroundOpen surgical debridement was the main treatment option for infected pancreatic necrosis (IPN). However, it was associated with significant trauma, leading to a higher mortality rate. With the development of minimally invasive surgery, the step-up treatment principle centered around minimally invasive intervention, significantly reducing the incidence of complications and mortality rates among IPN patients. However, few studies have reported the efficacy of laparoscopic retroperitoneal pancreatic necrosectomy (LRPN), a new minimally invasive debridement technique, in IPN patients with duodenal fistula (DF)—a severe complication of IPN. Therefore, we analyzed the effectiveness and safety of LRPN for treating IPN with DF and discussed the impact of DF on patient prognosis.MethodsWe retrospectively examined patients diagnosed with IPN between 2018 and 2023. The patients were divided into two groups based on the presence or absence of DF. Clinical characteristics, treatment strategies, clinical outcomes, and follow-up information were analyzed. A 1:1 propensity score-matching (PSM) method was used to assess differences in outcome indicators more accurately.ResultsA total of 197 patients were examined. After PSM, no significant differences were observed between the two groups in in-hospital mortality rate, incidence of single organ failure, rate of postoperative severe complications (Clavien–Dindo Classification ≥ 3), and intensive care unit stay (P > 0.05). However, the incidence of multiorgan failure, gastrointestinal bleeding, number of percutaneous catheter drainage (PCD) procedures, surgery cases, hospital stay, and hospitalization costs were higher in the DF group (P < 0.05). Of these patients, 71.6% (n = 141) were treated with PCD + LRPN, with a conversion rate of 6.38% to open surgery. A higher proportion of patients in the non-DF group showed improved clinical outcomes solely with PCD (22.6% vs. 2.4%, P < 0.05), whereas a higher proportion of patients in the DF group underwent PCD + LRPN (88.1% vs. 67.1%, P < 0.05). Both groups showed a significant reduction in the Sequential Organ Failure Assessment score 72 h postoperatively.ConclusionsFor patients with IPN and DF, the LRPN-centered step-up strategy was safe and effective. DF prolongs hospital stay and increases hospitalization costs for patients.

Adult Bladder Trauma Management

Bladder injuries occur in up to 10% of abdominal trauma cases, contributing to significant morbidity and mortality (10–22%). These injuries may result from blunt or penetrating trauma, as well as iatrogenic damage during surgical procedures. Accurate diagnosis and timely intervention are crucial to minimizing complications. Bladder injuries are classified into extraperitoneal (EP), intraperitoneal (IP), or combined types. Mechanisms of injury vary, with blunt trauma, predominantly from motor vehicle accidents, accounting for 60–85% of cases, and penetrating injuries, such as gunshot wounds, comprising 15–51%. Evaluation includes clinical assessment, cystography, and CT imaging, supplemented by cystoscopy for iatrogenic cases. Management strategies range from conservative catheterization to surgical repair, depending on injury type and severity. EP injuries, the most common type (63%), are frequently associated with pelvic fractures, whereas IP injuries (32%) typically result from blunt trauma to a distended bladder. Conservative management with catheter drainage suffices for most EP injuries; however, IP injuries necessitate surgical intervention to mitigate risks such as sepsis and peritonitis. Outcomes are influenced by concomitant injuries, which are often more critical than the bladder injury itself. Advanced imaging modalities, particularly CT cystography, offer high sensitivity and specificity for bladder injury diagnosis. While conservative management is preferred for minor injuries, indications for surgical repair include significant extravasation, ongoing urinary leakage, or associated injuries. Multidisciplinary approaches are essential for comprehensive trauma care. Bladder injuries are rare but carry substantial risks if unrecognized or inadequately treated. Timely diagnosis, guided by clinical suspicion and imaging, coupled with appropriate management strategies, is essential to optimize outcomes and reduce complications.

Management and prognostic prediction of pyogenic liver abscess in a Chinese tertiary hospital: Percutaneous needle aspiration vs catheter drainage.

Pyogenic liver abscess (PLA) is a serious infectious disease with high mortality. The aim of our study was to compare the efficacy of percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) for PLA and to assess risk factors for unfavorable prognosis. This retrospective study was performed between 2017 to 2019 in a Chinese tertiary care hospital. We compared the therapeutic effectiveness of PNA versus PCD for PLA and analyzed the risk factors of treatment failure in PLA patients using multivariate logistic regression. A total of 445 patients with PLA were enrolled. The ultrasound-guided percutaneous treatment showed good therapeutic effects on PLA, with a total primary cure rate of 90.1%. PNA appeared to have advantages over PCD, with higher success rates, lower costs, and shorter hospital stays, as well as fewer puncture-induced pain, especially in patients with abscesses of 5-10 cm in diameter. The presence of positive blood culture (OR: 3.32, p = 0.002), liver cirrhosis (OR: 3.31, p = 0.023), and the length of fever resolution (OR: 1.043, p = 0.001) were independent predictors of primary treatment failure. PNA is more advantageous than PCD and is worth considering as a first-line treatment.

Emphysematous pancreatitis: Diagnosis, treatment, and prognosis.

Emphysematous pancreatitis (EP) is a rare, severe form of acute necrotizing pancreatitis characterized by gas in pancreatic or peripancreatic tissue, with a high mortality rate. To assess the diagnosis, treatment, and outcomes of EP through a series of case studies. This case series was conducted in intensive care units at the Second Affiliated Hospital of Anhui Medical University. Patients were included if they were diagnosed with pancreatic necrosis and gas via computed tomography from June 2018 to June 2024. Patients were categorized into early and late EP groups based on the timing of the appearance of the bubble sign and into extensive and common types based on the distribution range of the bubble sign. The data recorded included sex, age, aetiology, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, Bedside Index for Severity in Acute Pancreatitis score, subtype, gas distribution extent, aetiological diagnostic basis, pathogen categories, intervention measures, and prognosis. Among the 15 patients, 66.7% had a biliary aetiology and extensive type of EP, 47.1% had early-onset EP, and 73.3% had confirmed aetiological evidence [6 based on bacterial culture, 4 based on both routine culture and next-generation sequencing (NGS), and 1 solely based on NGS]. The common pathogens were Escherichia coli and Klebsiella pneumoniae. Six patients survived. Among the 2 patients who did not undergo percutaneous drainage or surgical treatment, 1 survived. Of the 6 patients who underwent percutaneous drainage, 2 survived, 2 survived after subsequent surgery, and 2 died without surgery. Among the 6 patients who underwent surgery alone, 5 died and 1 survived. Among the early-onset EP patients, 4 survived; among the late-onset EP patients, 2 survived. Among the common EP types, 4 survived; among the extensive EP types, only 1 survived. The mortality rate among patients with EP is considerable, and NGS enhances pathogen identification accuracy. Despite the debate on conservative vs surgical management, the STEP-UP strategy remains viable. Aggressive antimicrobial therapy, early percutaneous catheter drainage, and other minimally invasive interventions, along with delayed surgical intervention, may improve patient prognosis.

Subgaleal Hemorrhage with Periorbital Hematoma in a 6-Year-Old Boy Following a Road Traffic Accident: A Case Report

Subgaleal hemorrhage is a rare yet potentially life-threatening condition in pediatric patients, characterized by bleeding in the subgaleal space and is often associated with head trauma. Although it is commonly observed in neonates following vacuum extraction, its occurrence following road traffic accidents is rare and under-reported. This case report presents a 6-year-old Nigerian boy who developed subgaleal hemorrhage and periorbital hematoma following a road traffic accident. Owing to the unavailability of a CT scan, diagnosis was achieved using skull X-ray and ultrasound. Tranexamic acid was administered as part of the medical management. Surgical intervention was performed to control the hemorrhage, with approximately 320ml of blood evaculated, and no drainage catheter was left in situ. The patient responded well to treatment, with full recovery observed during follow-up. This case highlights the importance of early recognition and intervention in subgaleal hemorrhage, particularly in resource-limited settings.

Clinical Outcomes of Liver Abscesses in Adults: A 10-Year Experience at a Tertiary Care Center in Northern India.

Purpose Hepatic abscesses remain a significant clinical challenge due to high morbidity and mortality. This research aims to examine the etiological spectrum, management approaches, clinical features, and results in hepatic abscesses in a tertiary care facility in northern India, emphasizing the distinctions among pyogenic liver abscesses (PLAs) and amoebic liver abscesses (ALAs). Methods This retrospective study was done at GSVM Medical College, Kanpur, analyzing 725 patients with hepatic abscesses over a 10-year period. Patients were included based on confirmed diagnoses of ALAs or PLAs through clinical, serological, and microbiological evidence. Data on demographics, clinical presentation, imaging findings, laboratory results, and management approaches were extracted from hospital records.IBMSPSSStatistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States)was employed for statistical analysis, and continuous variables were displayed accordingly as means or medians and categorical variables as frequencies. Subgroup analyses were conducted based on abscess characteristics, including size, location, and etiology. Results Of the 725 patients analyzed, the mean age was 42.7 ± 15.8 years, with men comprising 85.93% of the cohort. ALAs accounted for 82.3% of cases, while PLAs comprised 12%. PLA cases frequently involved Gram-negative pathogens, such as Escherichia coli and Klebsiella pneumoniae, with 64% of PLA patients exhibiting positive pus or blood cultures. Common presenting symptoms included abdominal pain (87%) and fever (84.5%). Significant comorbidities included alcoholism (43.6%) and diabetes mellitus (34.2%). Right lobe involvement was predominant (75.9%), and multiple abscesses were noted in 47.5% of patients. Complications included pleural effusion (53.9%), abscess rupture (16.3%), and systemic inflammatory response syndrome (25.7%). Management strategies comprised antibiotics, percutaneous catheter drainage (74.8%), and needle aspiration (43.4%), with conservative treatment being effective in smaller abscesses. Mortality rates were low, at 1.6% for ALAs and 1.5% for PLAs. Hospital stays were shorter for PLA cases (median: five days) compared to ALAs (median: 7.3 days). Conclusion This study underscores the predominance of ALAs in endemic regions like India and highlights the significant role of Gram-negative bacteria in PLAs. Tailored management strategies, including percutaneous interventions and early antibiotic therapy, were associated with favorable outcomes and low mortality. However, the emergence of antimicrobial resistance in PLAs warrants robust antimicrobial stewardship. Public health measures focused on sanitation and clean water are critical to reducing the prevalence of ALAs.

Optimal indication of adding pancreatic juice cytology in the diagnosis of malignant intraductal papillary mucinous neoplasm of the pancreas.

Positive pancreatic juice cytology (PJC) is an important finding when considering surgical resection in patients with intraductal papillary mucinous neoplasm (IPMN); however, guidelines do not recommend endoscopic retrograde cholangiopancreatography (ERCP) for PJC. This study aimed to clarify the findings worthy of adding PJC for diagnosing high-grade dysplasia (HGD) and invasive carcinoma (IC) in patients with IPMN. Patients with IPMN who underwent preoperative PJC and surgical resection at Hiroshima University Hospital were enrolled, and the diagnostic yield of malignant IPMN based on PJC and clinical and imaging findings and the incidence of post-ERCP pancreatitis (PEP) were retrospectively analyzed. Of the 129 eligible patients, 61 (47%) had malignant tumors (29 HGD and 32 IC). The diagnostic yields of PJC were as follows: 33%, 97%, 91%, 62%, and 67% for sensitivity, specificity, and positive predictive value, and negative predictive value, respectively. Multivariate analysis revealed that an abrupt change in the pancreatic duct caliber was an independent predictive factor of true-positive PJC (hazard ratio: 15.81, P=0.001), with a diagnostic sensitivity of 86% for PJC in these patients. The incidence rate of PEP was 19%, and the pancreatic body and tail lesions, main pancreatic duct diameter <10mm, and placement of a nasopancreatic drainage catheter were significant risk factors for PEP. Although PJC is generally not recommended for patients with IPMN, it is worth considering for the determination of treatment strategies in patients with abrupt changes in the caliber of the pancreatic duct with distal pancreatic atrophy.

Whole Lung Lavage in Autoimmune Pulmonary Alveolar Proteinosis: Unique Challenges in a Resource-Limited Setting.

Autoimmune pulmonary alveolar proteinosis (PAP) is characterized by antibodies to granulocyte-macrophage colony-stimulating factor (GM-CSF), alveolar macrophage dysfunction, and surfactant accumulation. Whole lung lavage (WLL) is the treatment of choice in patients with PAP and severe hypoxemia. In resource-limited settings, WLL can be performed in the intubated, anesthetized patient who is being one lung ventilated using a Y-type bladder irrigation catheter for saline instillation and drainage.

Clean Intermittent Catheterisation via a Mitrofanoff Is Superior to Long Term Suprapubic Catheters for Bladder Drainage

AimSome children require long-term drainage of the bladder but do not tolerate clean intermittent catheterisation (CIC) urethrally. We aimed to compare long term suprapubic catheter (SPC) drainage vs Mitrofanoff conduit (allowing CIC) by comparing the survival of the drainage methods and rates of urinary tract infection (UTI). MethodRetrospective review of a single surgeon's experience (2007–2023). Data collection included diagnosis, age at procedures, date of surgery, date of most recent follow-up and date and reason for unplanned surgery. For SPCs, initial insertion of SPC and then conversion to a Foley catheter under GA was taken as normal (event free survival) and only further operations were counted as complication events. For Mitrofanoffs, any subsequent operation was counted as a complication.Data were given as a number (%) or median (interquartile range) as appropriate. Data analysed by Fisher exact and Mann–Whitney U-test. Kaplan Meier (KM) survival of drainage routes was compared, P < 0.05 taken as significant. ResultsThere were 45 patients (n = 86 SPC episodes) compared to 108 patients (n = 110 Mitrofanoff procedures). Data were available in 73 SPC episodes and 109 Mitrofanoff episodes, including 3 redo procedures (one from another centre). There was no difference in gender (SPC group, 67 % male vs. Mitrofanoff group, 77 %; N.S.). There was no difference in age at procedure [7.5 (2.9–11.5) years vs 8.3 (5.9–11.4) years respectively; N.S.)KM comparison showed that Mitrofanoff have a better event-free survival than SPC (91 % vs 52 % at 1 year; 80 % vs. 13 % at 5 years; P < 0.0001). Paired data showed a significant (86 %) reduction in rate of UTI with conversion from SPC to Mitrofanoff drainage in 15 patients; SPC: 0.13 (0–0.46) UTIs/month vs subsequent Mitrofanoff: 0.02 (0–0.08) UTI/month, P = 0.04). ConclusionSPCs had a much higher rate of unplanned surgery than Mitrofanoffs, creating a considerable unplanned burden of care for families and clinical staff. For long-term bladder drainage CIC via a Mitrofanoff conduit should be considered in preference to SPC where urethral CIC is not possible.

Exploring the optimal indwelling pleural catheter drainage technique in India.

Exploring the optimal indwelling pleural catheter drainage technique in India.

Splenic abscess: treatment options in a disease with high mortality

BackgroundSpleen abscess is a rare and serious condition. Splenectomy and imaging-guided percutaneous catheter drainage (PCD) are the methods used in the treatment, but there is still a debate about the appropriate treatment for the patient.MethodsThe results of 16 patients treated for spleen abscesses in our clinic between 2012 and 2021 were reviewed. The patients were divided into two groups according to splenectomy and PCD.ResultsIn the study, PCD was performed in 11 patients (68.75%), but three of these patients required splenectomy due to inadequate drainage. The patients who underwent splenectomy were significantly younger than the patients who underwent PCD (p < 0.05). One patient underwent PCD and 2 patients underwent splenectomy after PCD died.ConclusionSpleen abscess is a serious clinical picture that requires a multidisciplinary approach and is life-threatening. New clinical studies are needed for a treatment algorithm that will provide good results.

Urine leak and vascular complications following robotic partial nephrectomy: a contemporary single-center experience.

Urine leak (UL) and vascular complications (VC), i.e., pseudoaneurysms and arteriovenous fistulas are well-described complications of robotic-assisted partial nephrectomy (RAPN). Historically, UL incidence ranges from 0.3 to 17% and VC from 0.8 to 5.6%. We report the contemporary experience of UL and VC from a single, high-volume center in cases of RAPN. 447 patients were identified from an IRB-approved Renal Tumor Database of 2174 cases who underwent RAPN from 1/2017 to 5/2023. VC occurred in 9 cases (4 pseudoaneurysms, 1 AV fistula, 4 concurrent AV fistula/pseudoaneurysm), UL occurred in 9 (2.0%), and there was one concurrent case of VC and UL. Collecting-system entry occurred in five VC cases and five UL cases. For VCs, the median nephrometry score and maximal tumor diameter was 8 (IQR 3.0) and 3.8 (0.9)cm, respectively, and 8 (3.0) and 3.7 (1.1)cm for UL cases, respectively. Most complications occurred with tumors ≤ 4mm from the collecting system (n = 7 VC, n = 6 UL). VCs presented after 18 (6.0)days, 6 with gross hematuria; 3 required clot irrigation, 1 required continuous bladder irrigation, and 8 required embolization. No patients required postoperative transfusion. Patients with UL presented after a median of 1 (12)day, with 5 cases detected by elevated creatinine in drain fluid and the remainder detected on routine ultrasound. The duration of UL was 13 (41)days with only 2 cases requiring stenting and one case requiring a drainage catheter. No patients required kidney re-operation or removal. Our rate of VC and UL following RAPN are low and consistent with other contemporary series. Complications occurred in patients with high nephrometry scores or tumors located close to the collecting system. Both complications generally present early and can be managed without kidney re-operation or removal.

Interventions for Fluid Collections in Acute Pancreatitis: Expanding Horizon

AbstractManaging pancreatic fluid collections (PFCs) in acute pancreatitis has undergone a paradigm shift. Endoscopic and surgical advancements have led to the development of safer and more effective techniques for draining PFCs and performing necrosectomy. These techniques have been effectively incorporated into the step-up approach. Percutaneous catheter drainage remains the cornerstone for managing PFCs, although its role has changed with the advent of endoscopic ultrasound-guided techniques. PFC management relies heavily on interdisciplinary collaboration. All the techniques must be considered complementary rather than competitive. The preference for one method over the other must consider the patient factors and availability of expertise. This review entails a detailed discussion of the intervention of PFCs with the latest available evidence.