Failure Of Percutaneous Drainage Research Articles

Risk factors indicating the need for surgical therapy in patients with pyogenic liver abscesses.

Percutaneous drainage (PD) and antibiotics are the therapy of choice (non-surgical therapy [non-ST]) for pyogenic liver abscesses (PLA), reserving surgical therapy (ST) for PD failure. The aim of this retrospective study was to identify risk factors that indicate the need for ST. We reviewed the medical charts of all of our institution's adult patients with a diagnosis of PLA between January 2000 and November 2020. A series of 296 patients with PLA was divided into two groups according to the therapy used: ST (n = 41 patients) and non-ST (n = 255). A comparison between groups was performed. The overall median age was 68years. Demographics, clinical history, underlying pathology, and laboratory variables were similar in both groups, except for the duration of PLA symptoms < 10days and leukocyte count which were significantly higher in the ST group. The in-hospital mortality rate in the ST group was 12.2% vs. 10.2% in the non-ST group (p = 0.783), with biliary sepsis and tumor-related abscesses as the most frequent causes of death. Hospital stay and PLA recurrence were statistically insignificant between groups. One-year actuarial patient survival was 80.2% in the ST group vs. 84.6% in the non-ST (p = 0.625) group. The presence of underlying biliary disease, intra-abdominal tumor, and duration of symptoms for less than 10days on presentation comprised the risk factors that indicated the need to perform ST. There is little evidence regarding the decision to perform ST, but according to this study, the presence of underlying biliary disease or an intra-abdominal tumor and the duration of PLA symptoms < 10days upon presentation are risk factors that should sway the surgeons to perform ST instead of PD.

Pyogenic Liver Abscess: Contemporary Trends in a Tertiary Institute.

Pyogenic liver abscess (PLA) is an uncommon but potentially life-threatening condition. In recent years, advances in diagnostics and management have led to early diagnosis and treatment and decreased mortality. We present recent data from a large series of patients with PLA and examine the trends in the management of PLA over a period of 50 years. The medical records of all patients admitted to the Shaare Zedek Medical Center, Israel, between January 2011 and December 2021 with a primary or secondary diagnosis of PLA were reviewed retrospectively. : Ninety-five patients with PLA were identified. Thirty-eight (40%) were female. The median patient age was 66 years (range 18-93). The diagnosis of PLA in all patients was confirmed with abdominal computed tomography (CT). In twenty patients (21.1%), PLA was not diagnosed by the initial abdominal US. Most abscesses were right-sided. Biliary tract origin was the most common underlying cause of PLA (n = 57, 60%), followed by cryptogenic etiology (n = 28, 30%). Escherichia coli, Klebsiella pneumoniae, and Streptococcus species were most commonly identified. The most common primary treatment modality was percutaneous drainage (PD), which was performed in 81 patients (85.3%). Fourteen patients (14.7%) were treated medically without intervention, and two patients (2.1%) were treated surgically following a failure of PD. Four patients died as a direct result of PLA. Patients diagnosed with PLA are older, the male predominance is less pronounced, and the offending pathogens are likely to originate from the biliary tract. This study questions the utility of abdominal US as the initial diagnostic imaging in patients with suspected PLA (versus CT) and demonstrates improved outcomes for patients with PLA over the years.

Efficacy and safety of endoscopic ultrasound guided drainage of pseudocysts and walled-off necrosis after failure of percutaneous drainage.

Endoscopic Ultrasound (EUS) represents the gold standard for initial drainage of pancreatic fluid collections (PFC) due to various etiologies. However, data concerning salvage EUS drainage after initial percutaneous drainage are limited. The purpose of our study was to evaluate the clinical outcomes and safety of EUS-guided drainage of pancreatic collections after failure of percutaneous drainage. This retrospective study was conducted in a single, tertiary university center from August 2013 to January 2020. Indication was pancreatic collection after acute pancreatitis with PFC requiring EUS-guided drainage after failure of percutaneous drainage. Twenty-two patients with PFC after acute pancreatitis were included (mean age 64.1 ± 11.3years) of which 4/22 (18.2%) had pancreatic pseudocyst and 18/22 (81.8%) presented with a walled-off necrosis. Seventy-six interventions were performed among the 22 patients. Lumen-Apposing Metal Stent (LAMS) were used in 5/22 (22.7%) and double pigtail plastic stents in 17/22 (77.3%) of interventions with a median number intervention of 3 per patient (range 1 to 7). Technical success rate was 98.7% (75/76) with an overall clinical success of 81.8% (18/22). Procedure related adverse events rate was 9.1% (2/22) including one bleeding and one pancreatic fistula. Two non-procedure related deaths were observed. EUS-guided pancreatic collection drainage is clinically effective and safe after clinical/technical failure of radiological percutaneous management.

S100 Predictors of Need of Surgery in Patients With Acute Necrotic Collections Treated With Percutaneous Drainage

Introduction: Percutaneous drainage (PCD) is an important initial component of the “step-up” treatment strategy for the management of infected acute necrotic collections consequent to acute necrotizing pancreatitis (ANP). However, PCD alone has a high failure rate and these patients require additional necrosectomy. Delaying necrosectomy can increase morbidity and mortality and therefore, timely intervention is important. Identifying predictors of failure of percutaneous therapy can help in making timely management decisions. In this prospective single-center study, we attempted to identify predictors of failure of PCD in patients with infected ANC. Methods: Twenty-one patients (males:13, mean age:36.05years) (etiology: ethanol-related 47.6% (10/21), GSD related 28.6% (6/21) unknown19% (4/21) PEP 4.8% (1/21)) admitted with infected ANC who were treated with step-up strategy of initial PCD followed by endoscopic or surgical necrosectomy in non-responders were enrolled and studied prospectively. We studied the association between the success of PCD (survival without necrosectomy) & baseline clinical and investigational parameters including etiology, severity scores, C-reactive protein (CRP), computed tomography severity indices (CTSI), and PCD parameters (size of catheter & timing). Results: Nine (42.8%) patients with infected ANC were successfully treated with PCD alone whereas 12 (57.2%) patients either underwent necrosectomy or succumbed to the illness. The frequency of males was significantly higher (83.3% vs 33.33%) in the PCD failure group(p=0.03). The PCD was inserted later in the failure group as compared to the successful group (mean day of insertion of PCD being 20.5 days vs 15.1 days respectively; p=0.023). The mean SIRS score at admission (2.92 vs 2.33; p=0.102) & at 48 hours (3.5 vs 2.89; p=0.12), mean APACHE-II score (7.8 vs 7.0; p=0.508), mean ferritin levels (2916.9 vs 1033.4ng/mL; p= 0.394), and mean CRP levels (249.5 vs 209.6ng/mL; p=0.508.) were higher in the PCD failure group but did not reach statistical significance. The corrected calcium levels were lower(8.3 vs 9.0gm/dL p=0.069) in the PCD failure group. Also, the mean diameter of PCD catheters was more in the success group but the difference was not statistically significant (16.2 vs 14.7F; p=0.277). (Table) Conclusion: Male gender & delayed insertion of PCD seem to be associated with failure of PCD alone in patients with infected necrotic collections. Table 1. - Comparison of parameters between PCD Success and PCD Failure Group Parameter PCD Success group n=9 PCD failure group n=12 P Value Age 37.3±7.5yrs 36.8±13.4yrs 0.65 Males 3(33.33%) 10(83.33%) 0.03 BMI 24.5±4.3Kg/m2 22.4±3.8kg/m2 0.22 TLC 13871±6616.1/mm3 15014.2±7818.6/mm3 0.862 Platelet Count 321666.7±187813.7/mm3 304350.0±155671.1/mm 0.972 Ferritin Level 1033.4±628.2ng/mL 2916.9±2961.8ng/mL 0.394 Corrected Calcium 9.0±0.3gm/dL 8.3±1.2gm/dL 0.069 qCRP Levels 209.6±95.9mg/L 249±107.1mg/L 0.508 SIRS At admission 2.33±0.5 2.92±1.0 0.10 At 48hrs 2.89±0.93 3.50±0.52 0.12 APACHE-II 7.0±3.0 7.8±8.0 0.51 MMS 1.4±0.9 1.7±1.8 0.70 BISAP 2.1±0.3 2.3±0.8 0.55 Size of largest collection on CT 10.3±4.34cm 11.15±3.42cm 0.81 CTSI Score 7.3±2.5 7.8±2.5 0.65 mCTSI Score 8.7±1.7 9.2±1.3 0.60 Day of PCD placement 15.1±4.9 20.5±3.9 0.02 Size of largest PCD in the French scale 16.2±3.1 14.7±4.2 0.28

PSOAS ABSCESS:A RARE LOCALIZATION OF TUBERCULOSIS INFECTION

Psoas abscess is a rare disease with various etiologies. The most common pathogen in primary abscess is Staphylo coccus aureus. Crohns disease is the most common cause of secondary abscess. Mycobacterium tuberculosis is considered an extremely rare cause of psoas abscess, The clinical manifestation is insidious, the classic symptoms are pain and fever. Computed tomography (CT) is the gold standard in the diagnosis and follow-up of retroperitoneal abscesses. The treatment of choice is percutaneous drainage guided by imagery. Surgical drainage should be reserved for cases of failure of percutaneous drainage, if possible via the extraperitoneal route, but in the event of a secondary abscess, the transperitoneal approach is preferred to correct the original disease.

Laparoscopic management of liver abscess: a viable alternative in USG guided percutaneous drainage failure cases

Background: Liver abscesses are conventionally treated by ultrasonography (USG) guided percutaneous aspiration or drainage under antibiotic cover. We performed laparoscopic liver abscess drainage successfully in patients where medical management and percutaneous drainage had proven inadequate.Methods: Cases were received either from outpatient department (OPD) or were transferred from medical wards. Patients were first treated conservatively and percutaneous aspiration was attempted. Patients not responding to these treatment modalities were considered for diagnostic laparoscopy with drainage of abscess cavity and placement of 28 Fr drain under vision.Results: 20 patients with large liver abscess were treated successfully by laparoscopic drainage. Mean age in the study was 47 years (range 19-70 years) and average hospital stay was 5 days (range 4-12 days). Major postoperative morbidity or deaths were not registered. Patients with ruptured liver abscess, deep seated abscess cavity and medically unfit patients were excluded from the study.Conclusions: Laparoscopic drainage of liver abscesses, in combination with systemic antibiotics is a safe and viable alternative in all patients who require surgical drainage. It helps in the early return of gastrointestinal function and resumption of normal activities also potentially achieving better abscess drainage.

Effective exchange to a larger size catheter for a lung abscess with initial percutaneous drainage failure: a case report

BackgroundPercutaneous catheter drainage is an effective therapy for antibiotic-refractory lung abscesses. Pulmonary resection is usually considered in cases of drainage failure, although it remains controversial.Case presentationA 42-year-old man with antibiotic-refractory lung abscess underwent percutaneous abscess drainage with a 10-Fr pigtail catheter. However, adequate evacuation of the abscess content was not achieved, and his respiratory condition worsened and he required a ventilator. To achieve and maintain effective drainage, insertion of a larger size 28-Fr catheter to replace the 10-Fr catheter was performed under general anesthesia and one-lung ventilation with a double-lumen tube to isolate the left lung. Exchange with a larger size catheter was effective and achieved adequate drainage. The procedure was performed safely by expanding the route of the old catheter as a guide for accessing the abscess cavity. His condition immediately improved and he was discharged on day 40 post-catheter exchange with no complications and cured with a small residual thin wall cavity.ConclusionsSmall size catheters are generally recommended for initial percutaneous drainage; however, we argue that exchange with larger size catheters should be primarily considered instead of pulmonary resection in cases of initial drainage failure. This may avoid the need for pulmonary resection.

Tu1431 – Factors Predicting Failure of Percutaneous Drainage in the “Step-Up Approach” for Acute Necrotizing Pancreatitis: A 10-Year Retrospective Observational Study with a “Proactive” Percutaneous Drainage Strategy

Tu1431 – Factors Predicting Failure of Percutaneous Drainage in the “Step-Up Approach” for Acute Necrotizing Pancreatitis: A 10-Year Retrospective Observational Study with a “Proactive” Percutaneous Drainage Strategy

Management of Chyloretroperitoneum After Lumbar Surgery by Anterior Approach

Anterior lumbar approach, routinely used in spinal surgery, provides many advantages, specifically avoidance of manipulation and potential injury to nervous system structures; it also provides indirect central and foraminal decompression, with a complication rate of 1%-3%. Chyloretroperitoneum is a rare complication of spinal procedures using anterior lumbar approach. The aim of this study was to discuss diagnosis, treatment, and management of chyloretroperitoneum based on review of the international literature through2017. The literature review was conducted using the terms "chyloretroperitoneum," "spinal surgery," and "lymphocele." Additionally, an illustrative case of chyloretroperitoneum following anterior retroperitoneal lumbar approach was presented. In 33 cases, including the present case, clinical symptoms appeared after discharge in 75.8% (n= 25) and reflected direct mass effect. Abdominopelvic computed tomography permitted assessment of the fluid collection observed as a hypodense collection around the psoas muscle. In 24 cases, drainage of the chyloretroperitoneum was maintained for a mean duration of 2.9 days. Surgery was performed in 14 patients (42.4%) owing to lymphatic collection. In 5 cases, surgery was performed for direct lymphatic vessel treatment. Laparoscopic marsupialization of the collection and peritoneal fenestration were performed, especially after percutaneous drainage failure. Computed tomography was the most useful imaging modality for diagnosis and assessment of associated complications. If puncture alone is not sufficient and should be avoided, percutaneous computed tomography-guided drainage with sclerosing agent administration appears to be a safe and efficient first-line treatment. Laparoscopic fenestration should be used in cases of complicated or recurrent lymphoceles.

Sa1914 ENDOSCOPIC DRAINAGE VS PRECUTANEOUS DRAINAGE,SURGERY AND RETROPERITONEAL PERCUTANEOUS NEPHROSCOPE NECROSECTOMY OF PANCRETIC FLUID COLLECTION(PFC): A RETROSPECTIVE STUDY OF 145 PATIENTS

To compare and evaluate outcomes for patients of pancreatic fluid collection(PFC) undergoing endoscopic drainage(ED), percutaneous drainage(PD), surgery or retroperitoneal percutaneous nephroscope necrosectomy(RPN). Between January 2004 and December 2014, all patients of PFC in our hospital who received the above treatments were included. Rates of treatment success, adverse events, recurrence, length of hospital stay, and follow-up length for PFC disappeared were recorded retrospectively in all cases. Logistic regression analysis was performed to evaluate possible influence factors of treatment effect, and etiologic results of drainage fluid culture were summarized. In total, 145 patients were included in the study: 23 patients underwent ED(group A), 63 patients underwent PD[group B, which was divided into two sub groups B1(46 patients underwent PD alone) and B2(17 patients underwent PD and RPN)], 23 patients underwent surgery(group C and 36 patients underwent RPN( group D).Treatment success was significantly different between PD and surgery( 53.97% vs 95.65%, χ2=12.89 ， P ＜ 0.001), while it was similar among the five groups when group B was divided into two sub groups (B1 and B2) (χ2=4.8 ， P =0.308 ＞ 0.05).Meanwhile, RPN after failure of PD(group B2) significantly improved success rate according to group B(82.35% vs 53.97%,χ2=4.494 ， P =0.034 ＜ 0.05).Adverse events （ χ2=8.49 ， P =0.075 ＞ 0.05 ） and recurrence （ χ2=1.164 ， P=0.92 ） were similar among the five groups. Among the adverse events, the rate of give-up treatment attributed to MODS and mortality was totally 8.97%(13/145).Length of hospital stay, and follow-up length for PFC disappeared were significantly different among the five groups(Kruskal-Wallis test ， P ＜ 0.001). Particularly, follow-up length for PFC disappeared after surgery [29.5 (8.75∼41.75) days] was shorter compared with other four groups(P ＜ 0.05). Length of hospital stay in surgery and ED group was similar[10 （ 8∼14 ） vs 13 （ 5∼24 ） ,days].Logistic regression analysis indicated that baseline MODS before treatment influenced final treatment outcome [OR 12.281, 95%CI(3.246,44.026)].Drainage fluid culture suggested several common types of pancreatic pseudocyst pathogen infection: Escherichia coli (13.14%), Enterococcus (12.41%), Bauman Acinetobacter (10.22%), Klebsiella pneumoniae (8.76%), Candida albicans (8.03%), Pseudomonas aeruginosa (6.57%) and Staphylococcus aureus (5.11%). Compared to surgery and the minimally invasive surgical retroperitoneal approach(RPN), endoscopic drainage was associated with similar rates of treatment success, adverse events, recurrence and length of hospital stay. The follow-up length for PFC disappeared after surgery was shorter than other treatments. After failure of percutaneous drainage, retroperitoneal percutaneous nephroscope necrosectomy contributed to the improvement of success rate.

Delayed Cholecystectomy for Acute Cholecystitis in Elderly Patients Treated Primarily with Antibiotics or Percutaneous Drainage of the Gallbladder.

In high-risk patients with acute cholecystitis, antibiotics with or without percutaneous drainage of the gallbladder followed by delayed cholecystectomy (DC) can be performed. This study aimed to review our current management of elderly patients with acute cholecystitis treated with DC. All consecutive patients older than 70 with acute cholecystitis treated primarily with antibiotics with or without percutaneous drainage followed by DC between 2006 and 2015 were retrospectively reviewed. Overall 105 elderly patients had acute cholecystitis with planned DC. Ninety-three patients had antibiotherapy alone at first. Twenty-eight patients needed percutaneous drainage either in intention to treat (n = 12) or due to failure of antibiotic treatment (n = 16). Nine (32%) versus 11 patients (12%) required an emergency cholecystectomy (EC) due to failure of percutaneous drainage or antibiotic treatment, respectively. Eighteen patients (64%) underwent DC after percutaneous drainage. Postoperative morbidity was 39% (7/18) after DC in the percutaneous drainage group, and 1 patient died. Compared to DC after antibiotherapy (n = 53), elderly patients who underwent DC after percutaneous drainage (n = 18) had longer median hospital stay (10 days versus 3 days, P = .001) and higher postoperative complications (7/18 versus 6/53, P = .015). In elderly patients with acute cholecystitis, DC can be a good alternative to EC. However, after percutaneous drainage DC is associated with high complication rate and long hospital stay.

Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery.

Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications. The present study aimed to assess the efficacy, safety and modalities of endoscopic transmural drainage in the treatment of post-operative collections. Data of all patients referred to our dedicated multidisciplinary facility from 2014 to 2017 for endoscopic drainage of symptomatic post-operative collections after failure of percutaneous drainage or when it was deemed impossible, were retrospectively analyzed. Thirty-two patients (17 males and 15 females) with a median age of 53years old (range 31-74) were included. Collections resulted from pancreatic (n = 10), colorectal (n = 6), bariatric (n = 5), and other type of surgery (n = 11). Collection size was less than 5cm in diameter in 10 (31%), between 5 and 10cm in 17 (53%) ,and more than 10cm in 5 (16%) patients. The median time from surgery to endoscopic drainage was 38days (range 6-360). Eight (25%) patients underwent endoscopic guided drainage whereas 24 (75%) patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5months (1.2-24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy. The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.

Pyogenic liver abscesses: a contemporary analysis of management strategies at a tertiary institution

BackgroundDespite equivocal evidence, non-surgical management for pyogenic liver abscess (PLA) has become the standard of care at most institutions with surgery relegated to salvage therapy for those who fail less invasive means. The aim of this study was to describe the outcomes of a step-up approach to PLA management. MethodsA retrospective chart review was conducted at a single institution for patients diagnosed with PLA over a 10-year period. Demographic, radiologic, microbiological, treatment, and outcomes data were collected and analyzed. Results64 patients with PLA were identified. Initial treatment included antibiotics alone (n = 9), percutaneous drainage (PD) (n = 54), and surgery (n = 1). Surgery was ultimately required in 8 patients while 50 were cured with PD and 4 with antibiotics alone. Two (3%) patients died. Overall, PD carried an 85% success rate. ConclusionPLA patients should be initially treated non-operatively, barring indications for emergent surgery or inaccessibility for PD. Surgery can be reserved for failure of PD.

Incidence, Risk Factors and Management of Symptomatic Lymphoceles after Radical Retropubic Prostatectomy

IntroductionWe investigated the incidence, clinical course and risk factors for symptomatic lymphoceles after radical retropubic prostatectomy with pelvic lymph node dissection. Moreover, we explored parameters for the failure of percutaneous lymphocele drainage. MethodsThe incidence of symptomatic lymphoceles in patients with prostate cancer who underwent radical retropubic prostatectomy with pelvic lymph node dissection in our department between 2008 and 2013 was investigated retrospectively. The occurrence of lymphoceles was correlated with several clinical and histopathological parameters. In addition, logistic regression analysis was performed to assess the value of independent variables with regard to the development of symptomatic lymphoceles and failure of percutaneous drainage. ResultsA total of 599 consecutive patients treated with radical retropubic prostatectomy with pelvic lymph node dissection were included in the study, of whom symptomatic lymphocele had developed in 5%. Median time to diagnosis of symptomatic lymphocele was 22.5 days. Median time of percutaneous drainage was 16 days. Overall 43% of patients required surgical unroofing. On multivariate analysis age greater than 67 years (OR 3.27, p=0.005) and removal of more than 10 lymph nodes (OR 2.57, p=0.018) were independent predictors for the development of symptomatic lymphoceles. A significantly increased risk of percutaneous drainage failure was observed in patients who had a body mass index greater than 27 kg/m2 (OR 7.0, p=0.03), followed by a trend for those with a drainage volume of more than 375 ml 24 hours after puncture (OR 3.89, p=0.12). ConclusionsSymptomatic lymphocele will develop in 1 of 20 patients after radical retropubic prostatectomy with pelvic lymph node dissection. The number of lymph nodes removed constitutes an independent risk factor. Percutaneous drainage failure is associated with high body mass index and high drainage volume within the first 24 hours after puncture.

Acute pancreatitis.

To summarize recent data on classification systems, cause, risk factors, severity prediction, nutrition, and drug treatment of acute pancreatitis. Comparison of the Revised Atlanta Classification and Determinant Based Classification has shown heterogeneous results. Simvastatin has a protective effect against acute pancreatitis. Young black male, alcohol, smoldering symptoms, and subsequent diagnosis of chronic pancreatitis are risk factors associated with readmissions after acute pancreatitis. A reliable clinical or laboratory marker or a scoring system to predict severity is lacking. The PYTHON trial has shown that oral feeding with on demand nasoenteric tube feeding after 72 h is as good as nasoenteric tube feeding within 24 h in preventing infections in predicted severe acute pancreatitis. Male sex, multiple organ failure, extent of pancreatic necrosis, and heterogeneous collection are factors associated with failure of percutaneous drainage of pancreatic collections. The newly proposed classification systems of acute pancreatitis need to be evaluated more critically. New biomarkers are needed for severity prediction. Further well designed studies are required to assess the type of enteral nutritional formulations for acute pancreatitis. The optimal minimally invasive method or combination to debride the necrotic collections is evolving. There is a great need for a drug to treat the disease early on to prevent morbidity and mortality.

Percutaneous drainage for giant pyogenic liver abscess—is it safe and sufficient?

BackgroundLarge size is a predictor of failure of percutaneous drainage (PD) for pyogenic liver abscess (PLA). This article serves to establish the safety and sufficiency of PD in giant PLA (GPLA). MethodsA retrospective review of all GPLA patients treated at a tertiary care academic hospital from 2001 to 2011 was performed. A GPLA is defined as an abscess greater than or equal to 10 cm size based on imaging. ResultsForty patients (24 men, 60%) were treated for GPLA. All but 1 patient (98%) was managed with PD and the mean duration of drainage was 9 days (range 1 to 23 days). One patient underwent operative drainage. Three patients (7.7%) needed secondary procedures after the initial PD. One patient (2.6%) failed PD and subsequently underwent operative drainage. Among the patients who underwent PD, the overall morbidity was 25%; the median length of hospital stay was 13 days (range 5 to 31 days) and 1 (2.6%) mortality. ConclusionsLarge size itself is not a contraindication for PD. PD is safe and sufficient even in GPLA patients.

Predictors of postoperative outcomes for patients with diverticular abscess initially treated with percutaneous drainage

BackgroundThe aim of our study was to evaluate factors associated with percutaneous drainage (PCD) failure, complications, and stoma creation for patients undergoing sigmoidectomy for diverticular abscess. MethodsData for patients with diverticular abscess greater than or equal to 3 cm in diameter treated with initial PCD from 1994 to 2012 were identified. ResultsOne hundred fourteen patients (54% male) with a mean age of 57 years and a mean abscess diameter of 7.1 ± 2.4 cm were identified. American Society of Anesthesiologists 4 was the only independent factor associated with PCD failure (P < .001). On multivariate analysis, factors associated with postoperative morbidity (n = 42, 37%) included PCD failure (P = .02) and older age (P = .04), while risk for stoma creation was associated with PCD failure (P < .001), multiple PCD attempts (P = .002), older age (P < .001), Hinchey II (P = .03), and increased body mass index (P = .01). American Society of Anesthesiologists 4 was the only factor associated with permanent stoma (P = .02). ConclusionsIn patients with large diverticular abscess, a successful PCD is associated with reduced postoperative morbidity. However, a large proportion of patients require stoma creation. Significant comorbidity is associated with both failure of PCD and permanent stoma risk.

Outcomes of Percutaneous Drainage Without Surgery for Patients With Diverticular Abscess

Data on percutaneous drainage followed by observation for diverticular abscess is scant. The aim of this study is to assess outcomes of percutaneous drainage alone in the management of peridiverticular abscess. This is a retrospective study from a prospectively collected database. This study was conducted in a high-volume, specialized colorectal surgery unit. All patients with a diverticular abscess of at least 3 cm in diameter, treated between 2001 and 2012, who had prohibitive comorbidities or refused surgery after percutaneous drainage were included. The primary outcome measured was the treatment of diverticular abscess with percutaneous drainage alone. A total of 18 patients (11 surgery refusal, 7 comorbidity) were followed up until death, surgery for recurrent diverticulitis, or for a median of 90 (17-139) months. The median abscess size was 5 (3.8-10) cm, and the location was pelvic in 8 cases and intra-abdominal in 10. The mean duration of drainage was 20 ± 1.3 days, with the exception of 2 patients who only had aspiration of the abscess because of technical difficulty in drain placement. Three patients died of preexisting comorbidities between 2 and 8 months after percutaneous drainage. Seven of the surviving patients (7/15) experienced recurrent diverticulitis; 3 of these patients underwent surgery between 7 months and 7 years after the index percutaneous drainage. Of the remaining 4 cases of recurrence, one abscess was treated with repeat percutaneous drainage alone and 3 patients had uncomplicated diverticulitis treated with antibiotics. There were no significant associations between long-term failure of percutaneous drainage and the location of the abscess (p = 0.54) or previous episodes of diverticulitis (p = 0.9). This study was limited because of its retrospective nature, its nonrandomized design, and its small sample size. Percutaneous drainage alone was successful in avoiding surgery in the majority of this selected patient population with sigmoid diverticular abscess. Future studies should assess the appropriate indications for a more liberal use of percutaneous drainage not followed by elective surgery.

Risk factors for failure of percutaneous drainage and need for reoperation following symptomatic gastrointestinal anastomotic leak

BackgroundFew studies have evaluated the role of computed tomography-guided percutaneous drainage (PD) in the management of gastrointestinal (GI) anastomotic leaks. MethodsTen-year review of an interventional radiology database identified patients with symptomatic GI anastomotic leaks. Clinical, laboratory, radiographic, and operative characteristics following a technically successful PD which then failed and required reoperation for anastomotic leak were compared with those successfully treated with PD. ResultsSixty-one patients met study inclusion criteria. Fifty patients (82%) successfully underwent therapeutic PD of a perianastomotic fluid collection, with median follow-up of 16 months. Eleven patients (18%), at a median interval of 16 days, required reoperation following PD. A forward logistic regression showed cardiopulmonary disease (P = .03) and cancer surgery (P = .01) to be factors independently associated with the need for reoperation. The level of the anastomosis, initial fecal diversion/stoma, fluid collection size, and microbiology of aspirate did not predict failure of PD. ConclusionsCardiopulmonary disease and cancer surgery appear to be independent predictors for failure of PD and need for reoperation following a symptomatic GI anastomotic leak.

Predictive factors for failure of percutaneous drainage of postoperative abscess after abdominal surgery

BackgroundThe aims of this study were to assess the efficacy of percutaneous drainage of postoperative abscess after abdominal surgery and to identify factors predictive of failed drainage. MethodsData from 81 patients with postoperative abdominopelvic abscesses treated with percutaneous drainage were reviewed. Percutaneous drainage failure was considered when surgery was needed to control the sepsis. Predictive variables were sought using univariate and multivariate analyses with logistic regression models. ResultsSuccessful drainage requiring 1 (n = 46) or 2 (n = 17) procedures was observed in 63 patients (78%; 95% confidence interval, 67%–86%). Surgery was needed in 18 patients (22%; 95% confidence interval, 14%–38%). Residual collection after a first percutaneous drainage was the single predictive factor for failed drainage on univariate and multivariate analyses (P = .0275). ConclusionsPercutaneous imaging-guided drainage is a feasible and effective method for the treatment of abdominopelvic abscess, with a success rate of 78%. Residual collection is an independent predictor of unfavorable outcome after percutaneous drainage.