Image-guided Percutaneous Drainage Research Articles

Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review.

Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.

Step-Up Management in Acute Pancreatitis: A Tertiary Care Center's Experience From Southern India.

Background The clinical spectrum of acute pancreatitis (AP) ranges from mild disease to severe form associated with multiorgan failure, prolonged hospital stay, high morbidity, and mortality. Acute necrotizing pancreatitis (ANP) is a severe form of AP. This study evaluates AP's outcomes after applying principles of the step-upapproach in a tertiary healthcare center in south India. Methodology This prospective observational study was carried out from January 2021 to December 2022. The study population includes patients admitted to our department with AP. Results Ninetypatients were included in the study, most of them were middle-aged males with ethanol ingestion as the common etiology. Thirty-seven (41.1%) patients had mild AP, 25 (27.7%)had moderately severe AP, and 28 (31.1%)had severe AP. Organ failure at admission was noted in 36 (40%) patients. Twenty-three (25.5%) patients developed ANP. Infected necrosis was noted in 3 (3.33%) patients. Eighteen (20%) patients needed image-guided percutaneous drainage. Seven (38.8%) needed necrosectomy following percutaneous drainage. Mortality was observed in 8 (8.8%) patients. Specifically, mortality was noted in 6 (6.6%) patients who presented later in their disease course. Conclusions Percutaneous catheter drainage is a safe and effective therapy to tide over the initial phase of AP. It also serves as a bridging therapy till the patient is clinically fit for a necrosectomy. Severe AP cases presenting late in their course are associated with significant mortality even after step-upmanagement. Standardized protocols for referral and management are essential to obtain a good clinical outcome.

Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case–control study

BackgroundThis multicentre case–control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses.MethodsThis study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed.ResultsFailure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI − 0.66;3.70, P = 0.23).ConclusionsNon-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.Graphical abstract

Image-Guided Percutaneous Drainage of Abdominal Abscesses in Pediatric Patients.

Image-guided percutaneous abscess drainage (IPAD) is an effective, minimally invasive technique to manage infected abdominal fluid collections in children. It is the treatment of choice in cases where surgery is not immediately required due to another coexisting indication. The skills and equipment needed for this procedure are widely available. IPAD is typically guided by ultrasound, fluoroscopy, computed tomography, or a combination thereof. Abscesses in hard-to-reach locations can be drained by intercostal, transhepatic, transgluteal, transrectal, or transvaginal approaches. Pediatric IPAD has a success rate of over 80% and a low complication rate.

A case series of image-guided percutaneous drainage of abdominal aortic graft infection as bridge therapy.

Aortic graft infection (AGI) is a rare complication following endovascular aneurysm repair and is associated with substantial morbidity and mortality. The traditional management of AGI is intravenous antibiotic therapy and surgical explantation. In this case series, percutaneous drainage was used as a bridge therapy in the treatment of AGI. We report two cases, 78-year-old male and 57-year-old female, in whom image-guided percutaneous drainage was used to treat AGI in two contrasting contexts. Informed consent was obtained from both cases/relatives for publication. Both cases underwent successful percutaneous drainage of AGI utilized as a bridge therapy before definitive surgical reconstruction and graft explantation. Each patient had a different outcome. In the first case, the patient's comorbidities and severe disease state could not be overcome, resulting in his death. The second patient benefitted from the percutaneous drainage by allowing her more time ameliorate her malnutrition before definitive surgery. Data on the outcomes of percutaneous drainage of AGI is limited. The successful procedure described in this case series emphasizes the need to conduct more research to evaluate the safety and efficacy of this treatment approach before the surgical explantation.

Computed Tomography-guided Drainage with Modified Trocar Technique Using a Drainaway Drainage Kit.

Image-guided percutaneous drainage for abscesses is known as a safe and effective treatment. The computed tomography-guided percutaneous drainage kit Drainaway (SB Kawasumi Co., Ltd.), developed on the basis of a modified trocar method, has made it possible to complete the procedure only under computed tomography guidance without radiographic fluoroscopy. This study investigated the feasibility and safety of Drainaway for abscess drainage. In this retrospective observational study, 28 procedures in 27 patients (18 men and 9 women; age 67.0 ± 12.3 years) who underwent computed tomography-guided drainage using Drainaway between March and December 2021 at seven affiliated hospitals were analyzed. Patients with symptomatic, puncturable on computed tomography and refractory abscesses were included. Technical success (successful drainage with computed tomography alone), primary clinical success (successful drainage with Drainaway alone), secondary clinical success (avoidance of surgery), and complications were evaluated. The sites of the abscesses were the intraperitoneal, retroperitoneal, and thoracic cavities in 19, 5, and 2 patients, respectively, and subcutaneous tissue in 1 patient. The mean size of the abscesses was 7.1 ± 3.4 cm. The technical success rate was 96.4%; the ligament of the puncture route could not be penetrated in one case. The primary clinical success rate was 77.8%, whereas the secondary clinical success rate of catheter upsizing or replacement was 96.3%. Complications included one case of biliary pleurisy that required drainage. Drainaway is a useful device that allows abscess drainage using only computed tomography guidance without radiographic fluoroscopy.

Comparative Analysis of Percutaneous Drainage versus Operative Drainage of Intra-Abdominal Abscesses in a Resource-Limited Setting: The Tanzanian Experience.

Intra-abdominal abscesses (IAAs) are a major cause of morbidity and mortality worldwide. While image-guided percutaneous abscess drainage (PAD) has become the standard of care in many countries, over half of the global population does not have access to interventional radiology (IR) and are left with surgery as the only option for source control. The purpose of this study is to evaluate the development, implementation, and role of a PAD service in a resource-limited setting. A retrospective cohort study was performed on all patients who underwent percutaneous or surgical abscess drainage (SAD) of IAAs at Tanzania's national referral hospital from 10/2018 to 4/2021. Patients were identified through a match case search of institutional records and inclusion was confirmed through manual chart review. Demographics, patient presentation, procedural data, and clinical outcomes were recorded in a password-encrypted database and compared between groups. Sixty-three patients underwent abscess drainage: 32 percutaneously and 31 surgically. In the PAD group, there was a 100% technical success rate and a 0% complication rate. In the SAD group, there was a 64.5% technical success rate and ten deaths within 30 days (32.3%), and one additional complication requiring major therapy (3.2%) (p < 0.001). Results from this study demonstrate that PAD can be performed with high technical success and without complication by trained IR physicians in Tanzania. The development of a successful PAD program exemplifies the drastic need to support the growth of IR services in this setting.

Complications of Bile Duct Surgery: BILIOMA

Postcholecystectomy bilioma is an uncommon but potentially dangerous complication that can happen after gallbladder surgery. This disorder is characterized by the buildup of bile in the peritoneal cavity as a result of bile duct damage following surgery or bile duct leaking. The development of a postcholecystectomy bilioma may be asymptomatic or manifest as nausea, fever, and abdominal discomfort. Imaging studies such as computed tomography, magnetic resonance imaging, and ultrasound are used to make the diagnosis. The size, location, and presence or absence of complications all affect how postcholecystectomy bilioma is treated. Small, asymptomatic biliomas can be treated conservatively, while larger, more difficult biliomas may need invasive procedures like surgery or image-guided percutaneous drainage. The prevention of postcholecystectomy bilioma requires meticulous surgical technique and meticulous postoperative monitoring. Discussion: Postcholecystectomy bilioma is an uncommon but potentially dangerous complication that, if not identified and adequately managed, can have long-term effects. Preventing the development of biliomas is crucial and depends on excellent surgical technique and diligent postoperative monitoring. To avoid significant postcholecystectomy bilioma consequences, early detection is essential. Depending on the size, location, and presence or absence of complications, postcholecystectomy bilioma treatment may be conservative or invasive. method and meticulous postoperative care. Conclusion: To avoid major problems related to postcholecystectomy bilioma, early identification and effective treatment are essential. Individuals who have had a cholecystectomy should be informed of the possible dangers and side effects of surgery and should get medical help right away if they develop symptoms like nausea, fever, or stomach discomfort. The prevention of postcholecystectomy bilioma requires meticulous surgical technique and meticulous postoperative monitoring. In conclusion, postcholecystectomy bilioma is an uncommon but potentially dangerous complication that calls for prompt and appropriate medical care.

Management of Hematometra and Hematocolpos in Obstructive Mullerian Anomalies by Image-Guided Drainage with Interventional Radiology: A Multi-Institutional Case Series

Study ObjectiveTo describe cases of image-guided drainage of symptomatic hematometrocolpos from obstructive Müllerian anomalies as a temporizing measure to manage acute pain symptoms and delay definitive management of the obstructive Müllerian anomalies that require complex reconstruction MethodsInstitutional Review Board exemption from all included institutions was obtained. A retrospective case series from 3 academic children's hospitals of 8 females under the age of 21 with symptomatic hematometrocolpos due to obstructive Müllerian anomalies drained by image-guided percutaneous transabdominal vaginal or uterine drainage with interventional radiology was reviewed and described. ResultsEight pubertal patients with obstructive Müllerian anomalies (6 patients with distal vaginal agenesis, 1 patient with an obstructed uterine horn, and 1 patient with a high obstructed hemi-vagina) and symptomatic hematometrocolpos are reported. All patients with distal vaginal agenesis had greater than 3 cm lower vaginal agenesis, which would usually require complex vaginoplasty and use of postoperative stents. Given their immaturity and inability to use stents or dilators postoperatively or medical complexity, they subsequently underwent ultrasound-guided drainage of hematometrocolpos with interventional radiology to relieve pain symptoms, followed by menstrual suppression. The patients with obstructed uterine horns had complex medical and surgical histories requiring perioperative planning; they also underwent ultrasound-guided drainage of hematometra as a temporizing measure to manage acute symptoms. ConclusionPatients presenting with symptomatic hematometrocolpos due to obstructive Müllerian anomalies might not be psychologically mature enough to undergo definitive complex reconstruction, which requires vaginal stent or dilator use postoperatively to prevent stenosis and other complications. Image-guided percutaneous drainage of symptomatic hematometrocolpos serves as a temporizing measure by offering pain relief until patients are ready to undergo surgical management and/or to allow time for complex surgical planning.

Image-Guided Percutaneous Drainage Reduces the Need for Surgical Interventions in Patients with Tubo-Ovarian Abscess: A Cohort Study

Objective: Management of tubo-ovarian abscess (TOA) is a challenging healthcare problem especially in reproductive age women. The aim of this study is to determine the current role of image-guided primary percutaneous drainage in avoidance of surgical intervention in the management of TOA. Material and Methods: A total of 76 patients hospitalized in our tertiary care center with the diagnosis of TOA were retrospectively evaluated. The study population was divided into 2 groups based on the treatment modalities as antibiotic treatment (n=48) and image-guided percutaneous drainage (n=28) and evaluated in terms of clinical and laboratory characteristics and the requirement for surgical intervention. Results: Surgical intervention was required in 1 (3.6%) patient treated with percutaneous drainage and in 10 (20.8%) patients treated with antibiotics (p=0.036). The choice of treatment modality was independent of demographic characteristics, clinical and laboratory findings. The size of TOA in percutaneous drainage group was significantly larger compared to the antibiotic treatment group (mean 6.75±1.886 cm versus 5.92±5.88 cm, respectively, p=0.047). Rehospitalization during follow-up was higher among patients treated with antibiotics only compared to percutaneous drainage group (p=0.06). Conclusion: Percutaneous drainage is an acceptable treatment option including large-sized TOA and decreases the requirement of surgical intervention in selected cases.

Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: an updated systematic review and meta-analysis.

Liver abscesses differ in their aetiology, location, and number. Image-guided percutaneous drainage techniques are the currently used management for liver abscesses. We conducted our study to compare the clinical safety and efficacy of percutaneous needle aspiration (PNA) to percutaneous catheter drainage (PCD). A systematic review of major reference databases was undertaken in February 2022 for randomized controlled trials (RCTs) that compare PNA to PCD in treating liver abscess patients. The quality of the included trials was assessed using the Cochrane tool. Statistical meta-analysis was conducted using RevMan and open meta-analyst software. Fifteen RCTs were included in this review, with 1676 patients enrolled. The overall quality of the included trials was moderate, with most domains of unclear risk. PCD was superior to PNA in the success rate (RR=1.23; 95% CI [1.12, 1.36], P< 0.00001), time for achieving 50% reduction of cavity size (MD=-2.32; 95% CI [-3.07, -1.57], P< 0.00001), and time for clinical improvement (MD=-1.92; 95% CI [-2.55, -1.28], P< 0.00001). The two modalities did not differ in the days of hospital stay, duration of IV antibiotics, and time needed for total or subtotal reduction of cavity size (P= 0.36, P= 0.06 and P= 0.40, respectively). High heterogeneity levels were detected. Regarding major complications, the two modalities were equally safe (P= 0.39). PCD has a higher success rate and results in a faster 50% reduction in the abscess cavity size and clinical improvement. The two modalities are equally safe.

S1821 Rare Case of Recurrent Liver Abscess Caused by Choledocodoudenal Fistula in Ampullary Diverticulum

Introduction: Choledocodoudenal Fistula is a rare condition that may be caused by Choledocholithiasis, surgical or laparoscopic cholecystectomy, duodenal ulcer and tumor invasion. Choledocodoudenal fistula has no specific symptoms and may be accidentally discovered during upper GI endoscopy; but in some cases, it may lead to recurrent cholangitis and liver abscess. In this article, a case of recurrent liver abscess caused by Choledocodoudenal fistula in ampullary diverticulum is reported. Case Description/Methods: A 68-year-old male was admitted to outside facility because of abdominal pain and liver lesion on ultrasound. The abdominal CT showed large heterogeneous mass measuring more than 16*11 cm with single porta hepatis enlarged lymph node measuring about 2*1cm. Hepatocellular Carcinoma was suspected, but liver biopsy revealed active hepatitis with areas of necrosis and supportive inflammation. He was Referred to ALAhli Hospital for evaluation of liver abscess (Table). ERCP showed Tiny Ampullary orifice in large diverticulum (Figure). The injection of the contrast revealed a fistula at the apex of diverticulum with good drainage through it. In cases of liver abscess secondary to fistula complication, surgical or medical management may be needed. The liver abscess in this case study was treated medically. Discussion: A management strategy for CDF depends on correcting the underlying cause. As this condition is most commonly stone induced Endoscopic sphincterotomy is the gold standard for CBD stone extraction, however this approach has been found to be successful in only 12% of cases of large stone extraction, usually requiring additional therapies. Endoscopic papillary balloon dilation is an alternative approach to maintain the function of the sphincter and to reduce the morbidity associated with traditional endoscopic sphincterotomy. Currently, the approach of sphincterotomy followed by balloon dilation has provided the best outcomes. Patients with multiple abscesses should receive antibiotics for 4–6 weeks. Percutaneous drainage is the treatment of choice for liver abscesses. Operative drainage is indicated for patients with an identified intra-abdominal focus of infection and for those in whom percutaneous drainage is not feasible or has failed. Anatomic liver resection is rarely required and is withheld for cases of underlying surgical hepatobiliary pathology. In our patient we choose the medical treatment with antibiotics in combination with image-guided percutaneous drainage with excellent outcome.Figure 1.: Ampulla in large Diverticulum. Table 1. - Laboratory results of the patient upon admission to Al-Ahli Hospital WBC 7.8K/ul S. Albumin 2.1g/dl Sodium 133mEq/L HCT 50% SGPT 6mg/dl Potassium 3.7 mEq/L Hemoglobin 16.8% SGOT 15mg/dl Cholride 107mmol/l Platelets 173K/ul Bilirubin(T) 0.6mg/dl S. Creatinine 0.85mg/dl ESR 75mm/hour Bilirubin(D) 0.4mg/dl BUN 17mg/dl INR 1.3 ALK.PHOS 171 U/L CRP 190mg/l

Endoscopic step up: When and how

The management of (peri)pancreatic collections has undergone a paradigm shift from open surgical drainage to minimally invasive endoscopic, percutaneous, or surgical interventions. Minimally invasive interventions are associated with less morbidity and mortality compared to open necrosectomy. The (peri)pancreatic collections are currently treated with a “step-up approach” of an initial drainage procedure followed, if necessary, by a more invasive debridement. The step-up approach for management of (peri)pancreatic collections is mainly of two types, namely, surgical and endoscopic. Surgical step up includes initial image-guided percutaneous catheter drainage followed, if necessary, by minimally invasive video-assisted retroperitoneal debridement. Endoscopic step-up approach includes endoscopic transluminal drainage followed, if necessary by direct endoscopic necrosectomy. The development of endoscopic ultrasound and lumen apposing metal stents (LAMSs) has revolutionized the endoscopic management of (peri)pancreatic collections. Compared to surgical step-up approach, endoscopic step-up treatment approach has been reported to be associated with less new-onset organ failure, pancreatic fistula, enterocutaneous fistula, or perforation of visceral organ and shorter hospital/intensive care unit stay. This review will mainly focus on indications, techniques, timing, and recent advances related to endoscopic step-up approach in management of symptomatic(peri)pancreatic collections.

Empyema after image-guided percutaneous intercostal drainage of subdiaphragmatic collection: a case series.

BackgroundTreatment of subdiaphragmatic collection by intercostal image-guided drain placement is associated with a risk of pleural complications including potentially life-threatening pleural empyema. Descriptions of patient characteristics and clinical course of postinterventional pleural empyema are lacking. We aim to present characteristics, clinical course and outcomes of patients with empyema after intercostal approach of drain placement.MethodsData was collected as a retrospective single center case series and included adult patients with decortication for treatment of pleural empyema after image-guided percutaneous intercostal drainage of a subdiaphragmatic collection between 01.01.2009 and 31.01.2021.ResultsWe identified ten patients, nine male and one female, all suffering from subdiaphragmatic collection treated with intercostal drain. All patients developed pleural empyema after drain placement and received surgical decortication. Similarities between patients were drain placement under computed tomography (CT)-guidance (eight of ten patients), lateral position of the drain (seven of ten patients), drain insertion in the eighth intercostal space (ICS) (six of ten patients) and existing comorbidities as malnutrition (six of ten patients), diabetes (four of ten patients) and cancer (three of ten patients). The majority of patients had a prolonged length of hospital stay (LOS) with an average duration of 40 days. Nearly half of the patients needed intensive care unit (ICU) treatment and one patient died postoperatively from respiratory exhaustion.ConclusionsIn this series, empyema after intercostal drainage was associated with prolonged LOS and was potentially life-threatening. The most commonly shared features in our cohort were the high prevalence of comorbidities, drain insertion above ninth ICS as well as lateral position of the drain. These factors should be addressed in prospective studies to evaluate potential correlation with postinterventional empyema. For optimal management of patients with subdiaphragmatic collection treated by intercostal drainage, awareness of potential associated complications is crucial.

Influence of Percutaneous Drainage Surgery and the Interval to Perform Laparoscopic Cholecystectomy on Acute Cholecystitis through Genetic Algorithm-Based Contrast-Enhanced Ultrasound Imaging.

To discuss the optimal interval time between genetic algorithm-based ultrasound imaging-guided percutaneous drainage surgery (PTGD) and laparoscopic cholecystectomy (LC), 64 cholecystitis patients were selected as the research objects and evenly divided into experimental group (intelligent algorithm was adopted to recognize patients' ultrasonic images) and control group (professional doctors carried out diagnosis). 92 acute cholecystitis patients undergoing PTGD were divided into three groups. 30 out of the 92 patients received LC within 2 months and were defined as the early group. 32 were performed with LC within 2 to 4 months and were defined as the metaphase group. 28 underwent LC over 4 months and were defined as the late-stage group. The average operation time, the transition from LC to laparotomy, the average postoperative hospital stay, and the incidence of complications of the three groups were compared. The results revealed that the comparison of the diagnostic accuracy and comprehensive effectiveness between experimental group and control group demonstrated that the differences were statistically significant (P < 0.05). When the optimal interval of implementing LC after PTGD was realized, the corresponding values of the early group were 88.5 minutes, 16.67%, 8.13 days, and 13.75%. Those of the metaphase group were 49.91 minutes, 3.13%, 4.97 days, and 9.52%. Those of the late stage group were 68.78 minutes, 10.71%, 7.09 days, and 11.96%. To sum up, the diagnostic accuracy and comprehensive effectiveness of intelligent algorithm were higher than those of conventional ultrasound, and the optimal interval time of implementing LC after PTGD was 2 to 4 months.

Clinical outcomes of image-guided percutaneous drainage of pericardial effusion in cancer patients: A single-center retrospective analysis.

Catheter removal, survival, and recurrence rates after percutaneous pericardial effusion drainage in cancer patients are not fully understood. We evaluated the clinical outcomes of image-guided percutaneous pericardial effusion drainage in cancer patients. From January 2014 to September 2017, 113 percutaneous drainages for symptomatic pericardial effusion were performed in 100 cancer patients (median 60 years; range, 7-84 years) using ultrasound or angio-computed tomography. An 8-Fr drainage catheter was placed using the Seldinger technique via the subxiphoid (n=73), apical (n=23), or left parasternal (n=17) routes. Success rates, complications, and postprocedural clinical outcomes of drainages were retrospectively assessed. The technical and clinical success rates were 100% and 99%, respectively, without major complications. The median duration of catheterization and evacuated pericardial effusion volume were 6 days (range, 1-72 days) and 970ml (range, 140-7635ml), respectively. Catheters were removed after the first drainage in 86 cases (86%). Symptomatic pericardial effusion recurred in nine patients after catheter removal, in whom redrainages were performed 13 times with a median duration to redrainage time of 48 days (range, 13-529 days). During the follow-up period (median 106 days [range, 1-1396 days]), 61 patients died. The median survival was 140 days (95% confidence interval [CI], 95-276 days), and the median catheter-free survival was 111 days (95% CI, 60-152 days). Image-guided percutaneous pericardial effusion drainage for cancer patients is safe and helps alleviate symptoms. Additionally, catheter removal is possible in most patients, allowing a catheter-free period for patients.

Laparoscopic Drainage of a Kidney Abscess in a Difficult Location: A Case Report

Introduction: We present a case of a kidney abscess of difficult localization and due to Proteus mirabilis. Presentation of the Case: It is a 29-year-old male patient with no pathological history who presented with left low back pain with intermittent feverish sensation 2 weeks before his admission. The physical examination noted left lumbar tenderness and a fever of 38.50C. The biological assessment noted hyperleukocytosis with polymorphonuclear neutrophils predominance and an elevation of C-reactive protein with infected urine. Initially objectified by ultrasound, an uro-computed tomography was performed and revealed an anterior superior polar abscess of the left kidney measuring 6cm in diameter. Faced with the impossibility of percutaneous radiological drainage, we resorted to laparoscopic drainage and continuation of antibiotic therapy with successful evolution. Discussion: Kidney abscesses are rare and sometimes with difficult location, which compromises the therapeutic approach. Their prevalence varies from 1 to 10 per 10,000 admissions with serious vital or functional complications. The most frequently found germs are Gram-negative bacilli. Ultrasound and especially CT scan make the diagnosis in 90% of cases and guide treatment. Antibiotic therapy alone or associated with percutaneous drainage depending on the abscess size constitutes the basis of treatment; surgical drainage is reserved for failure or impossibility of percutaneous drainage. Laparoscopy drainage constitutes an alternative of drainage in this situation. Conclusion: Kidney abscesses constitute a rare pathology but with consequences that can compromise the vital or functional prognosis of the kidney. Proteus mirabilis is a rare germ but commonly responsible for kidney abscesses. The clinic and methods of diagnosis of this abscess are identical to those due to other germs. Antibiotic therapy associated with imageguided percutaneous drainage was successful in the majority of cases. Drainage by laparoscopy is an alternative for draining abscesses in difficult locations when percutaneous drainage is impossible or fails.

Management of pancreatic abscess following acute pancreatitis

Pancreatic abscess occurs as sequelae of acute pancreatitis. The standard treatment of infected pancreatic abscess is open surgical drainage and antibiotics. Recently, minimally invasive drainage methods such as image-guided percutaneous catheter drainage, transluminal endoscopic drainage through the stomach or duodenum, and retroperitoneal surgical drainage are becoming the trend. Open surgical drainage has a drawback of triggering a strong inflammatory response that can lead to multi-organ failure, bleeding, and gastrointestinal fistula unlike the minimally invasive approach. However, in the absence of facilities and expertise for minimally invasive drainage techniques, coupled with a patient with extensive/diffuse pancreatic necrosis and clinical deterioration, open surgical drainage may suffice. We report a case of pancreatic abscess which developed in a middle-aged man after few months of treatment and recovery from acute pancreatitis that was managed by open surgical drainage and parenteral antibiotics with good outcome.

Splenectomy versus Imaging-Guided Percutaneous Drainage for Splenic Abscess: A Systematic Review and Meta-Analysis.

Background: Splenic abscess (SA) is a rare, life-threatening illness that is generally treated with splenectomy. However, this is associated with high mortality and morbidity. Recently, percutaneous drainage (PD) has emerged as an alternative therapy in select patients. In this study, we compare mortality and complications in patients with SA treated with splenectomy versus PD. Patients and Methods: A systematic literature search of 13 databases and online search engines was conducted from 2019 to 2020. A bivariate generalized linear mixed model (BGLMM) was used to conduct a separate meta-analysis for both mortality and complications. We used the risk of bias in non-randomized studies of interventions (ROBINS-I) tool to evaluate risk of bias in non-randomized studies, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach for assessing quality of evidence and strength of recommendations. Results were presented according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: The review included 46 retrospective studies from 21 countries. For mortality rate, 27 studies compared splenectomy and PD whereas 10 used PD only and nine used splenectomy only. Data for major complications were available in 18 two-arm studies, seven single-arm studies with PD, and seven single-arm studies with splenectomy. Of a total of 589 patients, 288 were treated with splenectomy and 301 underwent PD. Mortality rate was 12% (95% confidence interval [CI], 8%-17%) in patients undergoing splenectomy compared with 8% (95% CI, 4%-13%) with PD. Complication rates were 26% (95% CI, 16%-37%) in the splenectomy group compared with 10% (95% CI, 4%-17%) in the PD group. Conclusions: Percutaneous drainage s associated with a trend toward lower complications and mortality rates compared with splenectomy in the treatment of SA, however, these findings were not statistically significant. Because of the heterogeneity of the data, further prospective studies are needed to draw definitive conclusions.

Risk factors and economic burden of postoperative anastomotic leakage related events in patients who underwent surgeries for colorectal cancer.

Nationwide research about the clinical and economic burden caused by anastomotic leakage (AL) has not been published yet in Korea. This study assessed the AL rate and quantified the economic burden using the nationwide database. This real world evidence study used health claims data provided by the Korean Health Insurance Review and Assessment Service (HIRA, which showed that 156,545 patients underwent anterior resection (AR), low anterior resection (LAR), or ultra-low anterior resection (uLAR) for colorectal cancer (CRC) between January 1, 2007 and January 31, 2020. The incidence of AL was identified using a composite operational definition, a composite of imaging study, antibacterial drug use, reoperation, or image-guided percutaneous drainage. Total hospital costs and length of stay (LOS) were evaluated in patients with AL versus those without AL during index hospitalization and within 30 days after the surgery. Among 120,245 patients who met the eligibility criteria, 7,194 (5.98%) patients had AL within 30 days after surgery. Male gender, comorbidities (diabetes, metastatic disease, ischemic heart disease, ischemic stroke), protective ostomy, and multiple linear stapler use, blood transfusion, and urinary tract injury were associated with the higher odds of AL. Older age, rectosigmoid junction cancer, AR, LAR, and laparoscopic approach were related with the reduced odds of AL. Patients with AL incurred higher costs for index hospitalization compared to those without AL (8,991 vs. 7,153 USD; p<0.0001). Patients with AL also required longer LOS (16.78 vs. 14.22 days; p<0.0001) and readmissions (20.83 vs. 13.93 days; p<0.0001). Among patients requiring resection for CRC, the occurrence of AL was associated with significantly increased costs and LOS. Preventing AL could not only produce superior clinical outcomes, but also reduce the economic burden for patients and payers.