Drainage Of Intra-abdominal Abscesses Research Articles

Mulitimodality fusion imagingを用いた腹腔膿瘍ドレナージの有用性

Mulitimodality fusion imagingを用いた腹腔膿瘍ドレナージの有用性

Morbidity of peripherally inserted central catheters in pediatric complicated appendicitis

BackgroundThe purpose of this study was to compare postoperative outcomes of pediatric patients with complicated appendicitis managed with or without a peripherally inserted central catheter (PICC). MethodsPatients aged ≤18 y in the Pediatric Health Information System database with complicated appendicitis that underwent appendectomy during their index admission in 2000–2012 were grouped by whether they had a PICC placed using relevant procedure and billing codes. Rates of subsequent encounters within 30 d of discharge along with associated diagnoses and procedures were determined. A propensity score–matched (PSM) analysis was performed to account for differences in baseline exposures and severity of illness. ResultsWe included 33,482 patients with complicated appendicitis; of whom, 6620 (19.8%) received a PICC and 26,862 (80.2%) did not. The PICC group had a longer postoperative length of stay (median 7 versus 5 d, P < 0.001) and were more likely to undergo intra-abdominal abscess drainage during the index admission (14.4% versus 2.1%, P < 0.001), and have a reencounter (17.5% versus 11.4%, P < 0.001) within 30 d of discharge. However, in the PSM cohort (n = 4428 in each group), outcomes did not differ between treatment groups, although the PICC group did have increased odds for the development of other postoperative complications (odds ratio = 3.95, 95% confidence interval: 1.45, 10.71). ConclusionsAfter accounting for differences in severity of illness by PSM, patients managed with PICCs had a similar risk for nearly all postoperative complications, including reencounters. Postoperative management of pediatric complicated appendicitis with a PICC is not clearly associated with improved outcomes.

NOTES for the management of an intra-abdominal abscess: transcolonic peritonoscopy and abscess drainage in a canine model

We studied natural orifice transcolonic drainage of intra-abdominal abscesses in a canine survival model to evaluate the difficulty of peritonoscopy and abscess drainage and the reliability of endoluminal colotomy closure. We placed a 7 cm nonsterile saline-filled latex balloon intra-abdominally to mimic or induce an abscess or inflammatory mass. Seven days later, we advanced a single-channel endoscope transanally into the sigmoid colon of the animal, made a colotomy and then advanced the endoscope intraperitoneally. We evacuated the identified abscess and placed a drain transabdominally. We closed the colotomy endoluminally with a tissue approximation system using 2 polypropylene sutures attached to metal T-bars. Two weeks later, we evaluated the colotomy closure at laparotomy. We studied 12 dogs: 8 had subphrenic balloon implants and 4 had interbowel loop implants. Eleven survived and underwent transcolonic peritonoscopy; we identified the "abscess" in 9. The colotomy was successfully closed in 10 of 11 dogs. Although abscesses were easily identified, the overall difficulty of the peritonoscopy was moderate to severe. One dog required colotomy closure via laparotomy, while 9 had successful endoluminal closure. After colotomy closure, 8 animals survived for 2 weeks (study end point) without surgical complications, sepsis or localized abdominal infections. On postmortem examination, all closures were intact without any adjacent organ damage or procedure-related complications. Natural orifice transluminal endoscopic surgery provides a novel alternative to treating intra-abdominal pathology. It is technically feasible to perform endoscopic transcolonic peritonoscopy and drainage of an intra-abdominal abscess with reliable closure of the colotomy in a canine experimental model.

Factors influencing the outcome of image-guided percutaneous drainage of intra-abdominal abscess after gastrointestinal surgery

PurposeTo improve the selection of patients for percutaneous abscess drainage (PAD) to treat postoperative intra-abdominal abscess after gastrointestinal surgery, we investigated the factors predictive of outcome.MethodsOf 143 consecutive patients with symptomatic postoperative intra-abdominal abscess after a gastrointestinal tract resection, 104 who underwent image-guided PAD as the initial treatment were reviewed. We assessed the possible associations between successful PAD and patient-, abscess-, surgical-, and drainage-related variables, and investigated the success rates of PAD for patients with vs. those without the factors related to successful outcome.ResultsBased on monitoring for 1 year after PAD, the success rate of this procedure was 85.6 % (89/104). Multivariate analysis revealed that the interval between surgery and the onset of abscess (p = 0.0234) and a single abscess (p = 0.0038) were independently associated with a successful outcome. Single late-onset abscess resolved completely within 10 weeks in 91.4 % of these patients.ConclusionsDespite new strategies aimed at preventing surgical site infection, PAD remains an important factor in the postoperative management of gastrointestinal surgery in Japan. Initial recognition of the day of onset and the number of abscesses are important prognostic factors.

A Rare Cause of Acute Abdomen: Urinary Bladder Rupture Due to Foley Catheter

Urinary bladder rupture is usually found due to blunt or penetrating traumas and iatrogenic injuries, and spontaneous intraperitoneal perforation is very rare. 57 years old male patient was consulted to general surgery department due to abdominal pain, nausia-vomiting and fever. He had Diabetes Mellitus, Multiple Sclerosis, Leriche Syndrome and operation for benign prostatic hypertrophy 5 years ago on his medical history which the case catheterised him urinary bladder himself frequently in nonsterile conditions. He did not care about sterility. On physical examination, suprapubic defence and rebound was noted more prominently on right lower quadrant. He was taken to operating room with the diagnosis of acute abdomen. On exploration, infection was seen on all layers of the whole urinary bladder, abscess formation and necrosis causing a microperforation which is detected by methylene blue was also present. Intraabdominal abscess drainage, cystostomy and primary suturing of the urinary bladder was performed. Patient died due to sepsis at the 9.th post operative day.

Percutaneous Ultrasound Guided Drainage of Abdominal Abscesses

Intraabdominal abscesses are common surgical pathologies that result from a myriad of causes and require a high index of suspicion to diagnose. Majority of the patient’s present critically ill requiring surgical drainage. The traditional open surgical drainage is associated with a high morbidity and mortality. Percutaneous ultrasound guided drainage which entails either needle aspirations or image guided catheter placements for a thick abscess is a suitable alternative to open surgical drainage. This study was aimed at evaluating our experience with ultrasound guided percutaneous drainage of intraabdominal abscesses in a Teaching hospital in north central Nigeria. Methodology Consecutive patients diagnosed to have intraperitoneal abscesses in a general surgery unit at Jos University Teaching Hospital over a 24 month period were studied. Results Twenty four patients were involved in this study. There were 14 males and ten females giving a male to female ratio (M: F =1.4:1). The mean age of the study population was 40+/- 19.3 with age range of 10-70years. Ten patients (41.7%) had abscesses in the liver, 6(25%) in the pelvis and 5(20.8%) were sub-phrenic in location, 3(12.5%) were psoas abscesses. Fifteen patients (62.5%) had their abscesses drained by needle aspiration while the remaining 9 (37.5%) were drained through placement of Foley’s catheters. There was no mortality in this study. In conclusion, percutaneous ultrasound guided drainage of abdominal abscesses is a viable alternative to open surgical drainage.

Intra-Abdominal Abscess Drainage: Interval to Surgery

Placement of percutaneous drainage catheters has become first-line therapy in the treatment of patients with intra-abdominal abscesses. Catheters can be used to avoid surgical intervention or to improve surgical outcomes. This article discusses the current evidence describing the optimal interval between percutaneous drainage procedures and surgery, focusing on patients with Crohn's disease, appendicitis, and diverticulitis.

Drainage of intra-abdominal abscesses with gastrointestinal fistula in Crohn’s disease using a sump drain via trocar puncture: a modified strategy

Drainage of intra-abdominal abscesses with gastrointestinal fistula in Crohn’s disease using a sump drain via trocar puncture: a modified strategy

Feasibility of Single-Incision Pediatric Endosurgery for Treatment of Appendicitis in 415 Children

Single-incision pediatric endosurgery (SIPES) has gained popularity for ablative procedures such as appendectomy in many pediatric surgical centers. This study evaluates the outcome of SIPES for treatment of appendicitis in our institution. After Institutional Review Board approval was obtained, data were prospectively collected on all patients undergoing SIPES appendectomy in our hospital from March 2009 through October 2011. The surgical techniques, operative times, complications, conversion rates, and outcomes were recorded. SIPES appendectomy was attempted in 415 children (mean age, 10.9 years; age range, 1.4-17.9 years; 266 males, 149 females; median weight, 43 kg; weight range, 9.8-146 kg). Intraoperatively, acute appendicitis was found in 298 cases and perforated appendicitis in 79 cases. Thirty-eight patients underwent interval appendectomy. Appendectomy was carried out solely as SIPES in 397 cases (96%). Median operative time was 40±16 minutes (37±16 minutes for fellows [n=284] and 46±15 minutes for residents [n=131]). There were three intraoperative complications, which could be handled during the procedure. Pathologic reports revealed inflammatory changes of the appendix (n=386), other pathology (n=11), and no pathologic change (n=18). Overall, 24 patients (5.8%) were readmitted for intra-abdominal abscess (n=14), umbilical wound infection (n=3), and other reasons (n=7). Twelve patients (2.9%) underwent reoperation: drainage of intra-abdominal abscess (n=8) (3 by the surgeon, 5 by the interventional radiologist), wound drainage (n=3), and right hemicolectomy for carcinoid (n=1). In perforated appendicitis the postoperative intra-abdominal abscess rate was 10 of 79 cases (12.7%), which is similar to the previous report with conventional laparoscopic appendectomy from our institution (13.6%). The wound infection rate (5 of 79 cases [6.3%]) was also similar to the previously report (6.8%) with conventional laparoscopic appendectomy for perforated appendicitis. Appendectomy can be accomplished successfully and safely using single-incision endosurgery in children with acceptable operative times without leaving any appreciable scar. Additional trocars are infrequently necessary. So far, the intraoperative and postoperative complication rates are comparable to those of triangulated laparoscopic appendectomy.

A Purely Laparoscopic Approach to Intra-abdominal Abscess Drainage and Retrieval of Retained Penile Prosthesis Reservoir

A Purely Laparoscopic Approach to Intra-abdominal Abscess Drainage and Retrieval of Retained Penile Prosthesis Reservoir

Percutaneous Transhepatic Drainage of Inaccessible Postoperative Abdominal Abscesses

The purpose of this study was to evaluate the safety and efficacy of transhepatic drainage of inaccessible postoperative intraabdominal abscesses under sonographic and fluoroscopic guidance. Between February 2005 and September 2010, 30 abscesses were treated in 30 patients. Procedures were performed with sonographic and fluoroscopic guidance under i.v. sedation and local anesthesia. Factors affecting results were evaluated statistically. The technical and clinical success rates were 100% and 97%. The procedures were performed with 8-, 10-, and 12-French locking pigtail catheters. The catheters were in place for a mean duration of 75 days if a fistula was present and 15 days in the absence of fistula. Major complications were not detected during treatment. The rate of minor complications (catheter dislodgement, obstruction, kinking) was 20%. Most of the complications were managed by exchange, revision, or increase in size of the catheter. When use of an 8-French catheter was compared separately with use of 10- and 12-French catheters, the rate of minor complications was found to be significantly higher for the 8-French group (p < 0.05). Five abscesses had fistulous communication with the pancreatic duct, jejunum, and biliary system. The mean duration of catheter use was increased by the presence of a fistula (p < 0.05). When single-microbe, polymicrobial, and culture-negative abscesses were compared, the difference between groups with respect to mean duration of catheter use was not statistically significant (p > 0.05). Mean duration also did not differ significantly between patients with an abscess volume greater than and those with an abscess volume less than 100 mL (p > 0.05). Transhepatic drainage of intraabdominal abscesses under sonographic and fluoroscopic guidance is safe and effective. Abscess content and volume did not affect drainage time, but the presence of a fistula increased the duration of catheter use. The rate of catheter-related complication was highest in the group with 8-French catheters. The rates in the groups with 10- and 12-French catheters did not differ significantly. We suggest the use of 10-French catheters for transhepatic drainage.

Percutaneous drainage of intra-abdominal abscess in children with perforated appendicitis

Because the surgical management of perforated appendicitis remains controversial, percutaneous catheter drainage (PCD) has gained favor for managing periappendiceal abscess in hemodynamically stable children. To determine the safety and effectiveness of PCD in children with perforated appendicitis and to identify any variables of prognostic value. We retrospectively evaluated clinical data and imaging features for 33 children undergoing PCD for periappendiceal abscess from October 2006 to February 2010. Those with preprocedural CT studies were assigned to one of three risk categories based on imaging features. Appendectomy was successfully postponed for all patients. Our technical success rate was 87.9%, with three recurrences (two requiring repeat drainage, one managed conservatively) and one possible complication (enterocutaneous fistula formation). Children with large and diffuse abscesses had a 50% rate of technical failure, which was significantly increased when compared to children with large but localized abscesses (P < 0.028). Extraluminal appendicolith, extraluminal gas, leukocytosis, ileus/obstruction and procedural variables were not reliable predictors of outcome. PCD can be effective for managing perforated appendicitis in children. Children with large and ill-defined abscess might be at increased risk for complication or recurrence.

An Innovative Technique for Intra-Abdominal Abscess Drainage using a Sump Drain by Trocar Puncture

An Innovative Technique for Intra-Abdominal Abscess Drainage using a Sump Drain by Trocar Puncture

Placement of double cannula using trocar puncture for abdominal abscess drainage

To study the effects of placement of double cannula using trocar puncture for intra-abdominal abscess drainage. A retrospective study was performed to investigate the clinical data of 32 patients undergoing intra-abdominal abscess drainage with double cannula placed using trocar puncture between June 2010 and December 2010. the location and size of the abscess was evaluated by ultrasound and CT. Placement of double cannula using trocar puncture was performed under CT or ultrasound guidance. Trocar puncture was successful in all the patients. One patient died of liver metastasis and multiple organ failure after surgery for pancreatic cancer. One patient required laparotomy and drainage because non-localization of sepsis from intestinal fistula. The remaining 30 patients experienced alleviation of septic symptoms after drainage and eventually cured. The mean healing time was(7±3) days. Two patients developed subcutaneous bleeding and were management by local compression. Placement of double cannula using trocar puncture for intra- abdominal abscess drainage results in satisfactory outcomes. This technique is especially suitable for abscesses with viscous drainage, those with the presence of phlegmon or necrotic debris, and those with multiple large cavities.

Laparoscopic drainage of intraabdominal abscess after appendectomy: an alternative to laparotomy in cases not amenable to percutaneous drainage

Purpose Postoperative abscesses after appendectomy occur in 3% to 20% of cases and are more common in cases of perforated appendicitis. Smaller abscesses are often amenable to antibiotic therapy, but surgical drainage remains the mainstay of treatment for larger collections. Surgical options generally include percutaneous drainage and open laparotomy. Laparoscopic drainage of these abscesses has not been well characterized in the pediatric population. Objective The aim of this study was to describe our experience with laparoscopic drainage of postappendectomy abscesses that were not amenable to percutaneous drainage. Methods This study is a retrospective review of all pediatric patients who underwent laparoscopic appendectomy for acute appendicitis at a tertiary pediatric medical center during a 4-year period (2006-2009). The review focuses on patients who developed abscesses after appendectomy, were unable to undergo percutaneous drainage, and were treated with laparoscopic abscess drainage. Results Twelve patients (7 male and 5 female) underwent laparoscopic drainage of postappendectomy abscesses. The mean age was 8.5 years old (range, 3-14 years). A clinical diagnosis of postoperative abscess was made when fevers, pain, and leukocytosis persisted despite broad-spectrum antibiotics. Computed tomography was performed in all patients. Abscesses ranged between 3 and 11 cm in size. The mean length of time between initial appendectomy and drainage procedure was 10 days. There were no complications specifically related to the laparoscopic drainage procedure. The mean length of the drainage procedure was 77 minutes (range, 30-196 minutes). The mean hospital length of stay after laparoscopic drainage was 6.5 days (range, 3-13 days) with patients maintained on intravenous antibiotics until afebrile and without leukocytosis. Conclusion Laparoscopic drainage is a safe and effective alternative for intraabdominal abscesses that occur after laparoscopic appendectomy. We recommend it as an alternative to open laparotomy when percutaneous drainage is not an option.

Abdominal Surgery after Lung Transplantation

Among 450 patients who underwent lung transplantation (LuT) between April 1994 and April 2009 at a single academic hospital, 75 received surgical consultation, and 52 underwent 65 abdominal operations. Operations included colectomy (17), cholecystectomy (14), exploratory laparotomy (10), ulcer repair (five), hernia repair (four), Nissen fundoplication (four), pancreatic debridement (four), ostomy takedown (two), drainage of intra-abdominal abscess (two), and major vascular procedure, gastrostomy, splenectomy, fascial closure, laparoscopic common bile duct exploration, and small bowel resection (one each). Fourteen patients (27%) died within 30 days of surgery. On univariate analysis, age, race, comorbidities, history of previous abdominal surgery, transplant type, and timing of surgery after transplant were similar between the patients who survived and died. On multivariate analysis, emergent surgery, multiple medical comorbidities, and male gender were predictive of 30-day mortality (P < or = 0.05). Ulcer repair, major vascular procedures, pancreatic surgery, splenectomy, and exploratory laparotomy were associated with > or =50 per cent 30-day mortality. This is the largest series reporting outcomes of abdominal operations after LuT. Elective operations in LuT patients are safe, whereas emergent operations carry an extremely high short-term mortality rate. Aggressive prophylaxis for ulcer disease and early elective intervention for potential surgical problems, such as gallstones and uncomplicated diverticulitis, should be considered.

Anesthesia for surgery for typhoid perforation in a rural African hospital

Background : Typhoid perforation is a condition commonly seen in developing countries including those of sub-Saharan Africa. Anesthetic management for surgery in typhoid perforation poses great challenges to the anesthetist practicing in Africa, especially in the face of limited resources. Materials and Methods : The anesthetic management of patients who underwent surgery for typhoid perforation at the SIM Hospital in Galmi, Niger Republic, between December 2004 and December 2005, was retrospectively reviewed. Results : There were 56 patients who had surgery for typhoid perforation during the period. Forty-one were males while 15 were females with a male:female ratio of 2.7:1. Their age ranged between 3 and 62 years with a mean of 23 years. Of these, 19 (33.9%) were children aged 15 years and below. Twenty-eight of the patients (i.e. 50%) were assessed as American Society of Anesthesiologists (ASA) physical status class IV, while 22 (39%) were ASA III and 6 (11%) were ASA V. Thirty surgeries (i.e. 53.6%) were done under spinal anesthesia, 9 (16%) under general inhalational anesthesia using halothane, 11 (19.6%) under ketamine anesthesia and 6 (10.7%) had drainage of intra-abdominal abscesses under local anesthesia. The overall mortality rate was 26.8%. The mortality rates following the different techniques of anesthesia were: spinal anesthesia 20%, general inhalational anesthesia 22%, ketamine anesthesia 18% and local anesthesia 83.3%. ASA III patients had a mortality rate of 9%, while the mortality rate was 28.6% in ASA IV patients and 83.3% in ASA V patients. Mortality was significantly related to the ASA status of the patient, while there was no correlation between mortality and anesthetic technique used. Conclusion: Proper preoperative resuscitation and a well-conducted anesthesia, using a technique that the anesthetist is well conversant with, appear to be the key to successful anesthesia in patients with typhoid perforation. Anesthetists practicing in rural Africa should be encouraged to acquire skill in the art of spinal anesthesia since it is cheap, easy to administer and can be safely utilized in these patients.

Utilidad de la urocinasa en el tratamiento de los abscesos intraabdominales mediante drenaje percutáneo

Background and objective The aim of the study was to analyze the usefulness of the treatment with Urokinase (UK) in percutaneous drainage of intra-abdominal abscesses (IAA). Patients and Methods Prospective, observational study of 50 patients treated in the Interventional Radiology Unit from University Hospital Lozano Blesa .Zaragoza. Spain. All procedures were performed under local anesthesia and ultrasound control, using Pigtail catheters (12–14 F). PH , D-dimer determination and microbiological studies were done from the initial aspirated sample. Subsequently, we injected 10 cc of UK (100,000 IU) 3 times a day for 3 days at least. Variables study: Resolution (Principal variable). Other variables included epidemiological, specific prognostic indexes (Mannheim, Altona); types of abscesses (location/origin), pH, D-Dímer and microbiology. Technical success, days of treatment, stay and mortality were also analyzed. Results Resolution: 86%; technical success: 100%; subsequent surgery: 3 cases. Mean treatment days: 7. Mean stay: 12 days. Death rate: 8% (PMI=/>13 and PIA II=/<−3,76). Conclusions The treatment of IAA through percutaneous drainage and washed with urokinase, is a safe, feasible and reproducible technique. The outcomes are similar to those reported previously.

EUS-guided transesophageal, transgastric, and transcolonic drainage of intra-abdominal fluid collections and abscesses

The therapeutic role of EUS is evolving. We report our experience with EUS-guided transesophageal, transgastric, and transcolonic drainage of various intra-abdominal fluid collections. To determine the technical feasibility and clinical outcomes of EUS-guided drainage. Prospective case series. Academic tertiary referral center. Patients referred for endoscopic drainage of intra-abdominal fluid collections; pancreatic pseudocysts amenable to conventional transgastric or transduodenal drainage were excluded. Single-step EUS-guided drainage of fluid collections by using a therapeutic linear-array echoendoscope with fluoroscopic guidance. Technical success, relief of symptoms, and procedural complications. Nine consecutive patients deemed appropriate for EUS-guided drainage of intra-abdominal fluid collections included transesophageal drainage of pseudocysts (n = 2), transgastric drainage of biloma (n = 2) and upper intra-abdominal abscesses (n = 2), transcolonic drainage of diverticular abscess (n = 1), Crohn's abscess (n = 1), and postoperative hematoma (n = 1). Endoscopic drainage was successful in all patients. Confirmation of complete resolution of the target fluid collection and symptom relief was achieved in 8 (89%) of 9 patients. Pneumothorax and mediastinitis developed in 1 patient after transesophageal drainage, which resolved with chest tube and medical therapy. During multiple stent placement, one of the stents was fully deployed into the abscess cavity in 2 patients; both were successfully retrieved either endoscopically (Crohn's abscess) or at the time of primary colonic resection (diverticular abscess). Limited number of patients. EUS-guided transenteric drainage of bilomas, hematomas, abscesses, and inflammatory fluid collections is technically feasible and generally results in complete drainage and symptom relief. Procedural complications may be minimized with more experience.

Image-guided drainage of multiple intraabdominal abscesses in children with perforated appendicitis: an alternative to laparotomy

Image-guided drainage of multiple intraabdominal abscesses in children with perforated appendicitis: an alternative to laparotomy