Drainage Of Intra-abdominal Abscesses Research Articles

Ileal Pouch—Anal Anastomosis

The aim was to assess the value of reoperative surgery for pouch-related complications after ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis and familial adenomatous polyposis. Between January 1981 and August 1989, 114 of 982 IPAA patients (12%) seen at the Mayo Clinic had complications directly related to IPAA that required reoperation. Among the 114 patients, the complications prevented initial ileostomy closure in 33 patients (25%), occurred after ileostomy closure in 68 patients (60%), and delayed ileostomy closure in the remaining patients. The salvage procedures performed included anal dilatation under anesthesia for anastomotic strictures, placement of setons and/or fistulotomy for perianal fistulae, unroofing of anastomotic sinuses, simple drainage and antibiotics for perianal abscesses, abdominal exploration with drainage of intra-abdominal abscesses with or without establishment of ileostomy, and complete or partial reconstruction of the reservoir for patients with inadequate emptying. None of the reoperated patients died. Reoperation led to restoration of pouch function in two thirds of patients and, of these, 70% had an excellent clinical outcome. However approximately 20% of the 114 pouches required excision. Excision was common, especially among patients who had pelvic sepsis. Salvage procedures for pouch-specific complications can be done safely and will restore pouch function in two thirds of patients. Complications after reoperation, however, may ultimately lead to loss of the reservoir in one in five patients.

Clinical Technique of Drainage for Postoperative Intra-Abdominal Abscess with Ultrasonographic Guidance

Clinical Technique of Drainage for Postoperative Intra-Abdominal Abscess with Ultrasonographic Guidance

Percutaneous Drainage of Hepatic and Intraabdominal Abscess Guided by Ultrasonobraphy

Percutaneous Drainage of Hepatic and Intraabdominal Abscess Guided by Ultrasonobraphy

Liver abscess in Crohn's disease: Report of four cases and review of the literature

Four patients with liver abscesses and Crohn's disease are described, and reports of 14 cases in the English language literature are reviewed. The incidence of liver abscess in patients with Crohn's disease (114–297 per 100,000) appears to be higher than that of liver abscess in the general population (8–16 per 100,000). Frequently the clinical manifestations of liver abscess are mistaken for a reactivation of Crohn's disease, and diagnosis is delayed. In comparison to patients with liver abscess in the general population, patients with Crohn's disease and liver abscess are considerably younger, are more likely to have multiple rather than solitary abscesses, and usually have a predisposing intraabdominal focus of infection, rather than a biliary one. Streptococci, especially Streptococcus milleri, are the most frequent cause of liver abscess in patients with Crohn's disease. Liver scanning should be performed routinely in patients with Crohn's disease in whom a febrile illness cannot be completely explained by bowel disease, or in whom fever does not respond to drainage of intraabdominal abscesses.

Repositioning catheters in surgically drained abscesses

Primary percutaneous drainage of intraabdominal abscesses under local anesthesia is an accepted method of treatment, with low morbidity and mortality. This technique was extended to patients with recurrent or secondary abscesses after initial primary surgical drainage. Four patients had abscesses drained operatively but were reevaluated several weeks later for recurrent fever. Sinography demonstrated an inadequately drained abscess cavity. Under fluoroscopic control and using local anesthesia, new drains were inserted and repositioned to provide better drainage. Resolution of the abscess cavity was documented radiographically, with improvement in the patients' clinical status.

Percutaneous catheter drainage of intraabdominal abscesses and fluid

Percutaneous catheter drainage of intraabdominal abscesses and fluid

Pyogenic Liver Abscess in Crohn's Disease

We describe six cases of pyogenic liver abscess occurring among 1227 Crohn's disease patients admitted to The Mount Sinai Hospital from 1960 through 1982, and review the features of the seven similar cases that have been previously reported. Mechanisms of formation of liver abscess in these 13 patients included direct extension of intraabdominal abscess (three cases), propagation via the portal vein (eight cases), biliary complications (one case), or metastatic cancer (one case). Five of the 13 patients died. All five deaths occurred among the eight patients with multiple abscesses; all five patients with solitary abscess survived. The mean age of the patients who died was 56 years, versus 37 years for the survivors. Three of the four patients treated with antibiotics only died; only two of the nine patients who underwent some form of drainage succumbed. Mortality was usually attributable to failure in making the diagnosis, especially as liver function test abnormalities were often subtle. Furthermore, the generally nonspecific clinical signs and symptoms were often obscured by underlying bowel disease. If a high index of suspicion is maintained, CT scanning and ultrasonography should reveal the lesion at an early stage, so that the necessary drainage procedure can be carried out, with or without concomitant resection of affected bowel and drainage of intraabdominal abscess.

Clinical Evaluation of Percutaneous Ultrasonically Guided Drainage for Intraabdominal Abscess

Clinical Evaluation of Percutaneous Ultrasonically Guided Drainage for Intraabdominal Abscess

Drainage of intraabdominal abscesses: A comparison of surgical and computerized tomography guided catheter drainage

Over an 18 month period, 130 patients were sent to the radiology department for diagnostic CT scans to localize intraabdominal abscesses. Of these patients, 71 (55 percent) were diagnosed as having intraabdominal abscesses. Fifty-one surgical procedures and 17 radiologic drainage procedures were done. The cure rate of patients undergoing an operative procedure was 88 percent, and the major complication rate was 23 percent. The cure rate of patients undergoing CT guided catheter drainage was 47 percent and the complication rate was 6 percent. CT guided catheter drainage may be the initial treatment of choice in institutions that specialize in invasive procedures performed by radiologists. However, in institutions that have not concentrated their efforts on this problem, the results may not be as good, and it may not be wise to assume these data have general applicability. Greater cooperative efforts between departments of radiology and surgery should lead to better results in treatment of intraabdominal abscesses and better understanding of the best methods of treating them.

Ultrasonically guided percutaneous aspiration and drainage of intra-abdominal abscesses

Ultrasonically guided percutaneous aspiration and drainage of intra-abdominal abscesses

Drainage of intraabdominal abscesses: Tactics and choices

The experience in treating 44 intraabdominal abscesses in 30 patients using percutaneous or surgical drainage was analyzed. Ultrasonography or computerized tomography-guided percutaneous drainage was highly satisfactory for the definitive treatment of single, accessible collections. Complex, multilocular, and phlegmonous lesions can also be treated by percutaneous drainage as a temporizing measure. Abscesses that are inaccessible, contain large amounts of necrotic material or are ill-defined, as well as those that have not responded to percutaneous drainage, require surgical exploration. Using these principles, there was only one death from sepsis in this series and three significant complications.

Drainage of hepatic, intraabdominal, and mediastinal abscesses guided by computerized axial tomography: Successful alternative to open drainage

Open surgical drainage of intraabdominal, intrahepatic, and mediastinal abscesses is well established. Although this may be the procedure of choice when there are indications for treatment of concurrent intraabdominal and mediastinal surgical disease, with the advent of computerized axial tomography and ultrasonography we have identified a patient population best served by percutaneous catheter drainage. The procedure involves precise localization using ultrasound or CAT scanning, fine needle aspiration for confirmation of diagnosis, and injection of radiopaque contrast medium with fluoroscopic observation to localize the abscess. Catheter placement is usually achieved by a Seldinger technique, although a trochar-cannula method is occasionally required. Our experience with 24 patients, as well as review of the world literature provides a cumulative experience of 252 patients, has led us to believe that this approach is successful 83 percent of the time with a minimal incidence of complications. Percutaneous catheter drainage of intrahepatic, intraabdominal, and mediastinal abscesses guided by computerized axial tomography is the treatment of choice in patients who do not have other indications for exploration.

The complicated septic abdominal wound.

Since 1975, we have treated 21 patients with severe postoperative liquefaction fascial necrosis of the abdominal wall (group A, 13 patients), postoperative fascial necrosis with an associated intestinal fistula(e) within the wound (group B, three patients) and postoperative fascial necrosis with multiple internal bowel fistulae causing continuing peritoneal contamination (group C, five patients). Management in group A included general exploratory laparatomy, drainage of intra-abdominal abscesses, debridement of necrotic fascia, and loose closure of the wound with polyethylene (Marlex) mesh. Treatment in group B consisted of suture closure of exposed bowel fistulae with skin flap coverage. Group C was treated with diverting jejunostomy and suture closure of distal fistulae to avoid hazardous dissection and preserve bowel length. Overall survival was 71%.

Drainage of abdominal abscesses guided by sonography.

0361 -803X/82/1 383-0527 $00.00 © American Roentgen Ray Society Fifty intraabdominal abscesses were treated by sonographically guided drainage combined with thorough irrigation of the cavity and local instillation of antibiotics. Twenty-eight were treated with one or more punctures and 22 were drained by means of a 1 2-1 4 gauge catheter. The method described is easy, gentle, and relatively atraumatic. With the exclusion of multicompartment abscesses, a success rate close to 9OtYo was obtained. It was concluded that sonographically guided puncture and drainage of intraabdominal abscesses is an important alternative to conventional surgical treatment, and it is recommended as a routine procedure.

Non-surgical drainage of intra-abdominal and mediastinal abscesses: a report of twelve cases.

Twelve patients with intra-abdominal or mediastinal abscesses were treated by percutaneous drainage. Three abscesses were subphrenic, three were adjacent to enteric leaks, two were intrahepatic, two were pancreatic pseudocysts, one was a pancreatic abscess extending to the lesser sac, and one was an infected adrenal hematoma. All 12 lesions were entered percutaneously using fluoroscopic guidance without traumatizing the adjacent normal tissue. Localization was frequently aided by computed tomography. Various catheters were positioned using basic angiographic techniques. Following drainage all patients had a favorable clinical response. Seven of the 12 patients required no surgical management. Careful radiologic follow-up and frequent changing of catheters was necessary in six of the patients. Two patients benefited from the addition of auxiliary drains. Five of the 12 patients were electively operated upon because of incomplete drainage of the abscess cavity. Causes of failure were: persistent anastomotic leak (two patients), sequestered, loculated extension of abscess cavity (two patients), or necrotic, viscous hepatic tissue requiring removal at laparotomy (one patient).

Non-surgical Drainage of Intra-abdominal Abscesses

Non-surgical Drainage of Intra-abdominal Abscesses