Drainage Of Infected Fluid Collections Research Articles

Step-up approach for acute infected necrotizing pancreatitis

Purpose of the study. The role of interventional methods of the treatment of acute infected necrotic pancreatitis depending on the morphological characteristics of the disease was determined.
 Material and methods. In present prospective cohort study, we included 96 patients with acute infected necrotizing pancreatitis. All patients were stratified according to morphologic features. Stepup approach with following steps of interventions was applied: percutaneous drainage of infected fluid collections, increasing of drainages diameter and number of it and open or minimally invasive necrosectomy. Clinical, laboratory, and instrumental monitoring were the defining indicators for the stopping of the treatment or for the passing to the next step of the treatment.
 Results. At the first step 7 of 96 patients with superficial focal necrosis, a necrosis index of 2 points and a category D were successfully treated. Other 89 patients were passed to the second step of treatment, of which 23 patients with superficial subtotal necrosis, necrosis index of 2 points and category E were successfully treated. Another 66 patients had undergone a third step of treatment. A multivariate regression analysis was conducted that allowed to identify predictive factors of inefficiency of using of percutaneous drainage interventions (stages I and II) as a final stage of treatment: transmural subtotal or total necrotizing pancreatitis (OR = 1,58; 95% CI 1,03–3,88; p = 0,033); Necrosis index of 4 or more points (OR = 3.19, 95% CI 1.57–8.37; p = 0,003); heterogeneous peripancreatic fluid collection (OR = 4,15, 95% CI 1,49–5.19; p = 0,001); The CT-index of severity of acute pancreatitis of 7 or more points (OR = 1,89, 95% CI: 1,03–3,43; p = 0,029).
 Conclusion. Step-up approach showed following results: 7,3% patients were treated at the first step, 24% – at the second step. Third step of treatment was applied in 68,7% of patients, of witch 12,5% was treated with laparoscopic necrosectomy. Predictors of ineffectiveness of ultrasound guided percutaneous drainage as the final treatment method are: necrosis index of 4 or more, heterogeneous paripancreatic fluid collections, subtotal and transmural necrotizing pancreatitis.

ACR Appropriateness Criteria® on Percutaneous Catheter Drainage of Infected Fluid Collections

Abnormal fluid collections occur throughout the body and represent a wide range of pathologies, including abscesses, pseudocysts, cysts, lymphoceles, seromas, bilomas, hematomas, urinomas, and infected neoplasms. Appropriate management often depends on clinical presentation, location, type of collection, early response to treatment, and the presence of complicating factors such as fistulas, septations, and increased viscosity. Physicians should carefully review clinical and imaging findings and make evidence-based recommendations for the best treatment, which may include antibiotics, needle aspiration, percutaneous drainage, endoscopic drainage, or surgical drainage. This paper addresses percutaneous catheter drainage and alternative treatment options for the management of fluid collections and is the result of evidence-based consensus by the ACR Appropriateness Criteria Expert Panel on Interventional Radiology.

Successful Video-Assisted Mediastinoscopic Drainage of Descending Necrotizing Mediastinitis

Descending necrotizing mediastinitis is an uncommon form of mediastinitis that can rapidly progress to septacemia. To date, the optimal surgical approach has remained controversial. We report a case of descending necrotizing mediastinitis that was treated successfully through a transcervical approach with video-assisted mediastinoscopy. In our case, because the abscess was separated into small compartments, especially in the paratracheal space, the abscess was drained using video-assisted mediastinoscopy. This less-invasive approach may be an option in the treatment of descending necrotizing mediastinitis, especially when the abscess in the paratracheal space is separated into small compartments.