Percutaneous Drainage Of Abdominal Abscesses Research Articles

Analysis of factors affecting the diagnostic yield for microbiologic diagnosis from percutaneous abdominal abscess drainage.

This study aimed to investigate the factors influencing the diagnostic yield of microbiologic diagnosis obtained through percutaneous abdominal abscess drainage procedures. We analyzed the influence of diverse clinical, radiological, and pre-procedural factors on the success of microbiologic diagnosis in this context. A retrospective analysis of patients who underwent percutaneous abdominal abscess drainage was performed to assess the factors affecting the diagnostic yield for microbiologic diagnosis. A total of 174 patients undergoing percutaneous abdominal abscess drainage was included. The use of antibiotics during the procedure and the spread of the abscess to other organs significantly increased the likelihood of obtaining a positive culture. Specifically, antibiotic use during the procedure raised the risk by up to 3.30-fold (OR = 3.30, 95% CI 1.48-7.65, p = 0.004), while abscess spread to another organ increased the risk by approximately 1.87-fold (OR = 1.87, 95% CI 0.98-3.61, p = 0.057). Additionally, abscesses containing air and abscesses with an air-fluid level were more common in patients with positive culture results. Other factors, such as gender, age, malignancy prevalence, and surgical history, did not significantly impact culture results. This study provides valuable insights into the factors affecting the diagnostic yield of microbiologic diagnosis from percutaneous abdominal abscess drainage. The findings underscore the importance of considering patient-specific variables and procedural aspects when planning and executing abscess drainage procedures. Further research can build upon these insights to develop evidence-based guidelines for optimizing the diagnostic yield of percutaneous abdominal abscess drainage procedures.

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.

Is routine imaging necessary prior to percutaneous abscess catheter removal?

Routine management after abscess drainage includes CT or fluoroscopic imaging to assess for residual abscess cavity prior to catheter removal. It is unclear whether this practice is necessary in patients without residual infection signs and symptoms. To evaluate safety of abscess catheter removal without follow-up imaging in patients without residual clinical or laboratory signs of infection and catheter output < 10cc/day for 2 consecutive days. In this IRB-approved, HIPAA compliant, retrospective study, consecutive patients that underwent percutaneous CT-guided drainage of a single abdominal or pelvic abscess between 01/2015 and 12/2017 in a single tertiary academic institution with or without follow-up imaging prior to catheter removal were included. In our institution, catheters are routinely removed without imaging if there are no clinical (fever, pain) or laboratory (elevated WBC count) signs of infection and catheter output is < 10cc/day for 2 consecutive days. Patients' and abscess's characteristics, repeat imaging data, and need for re-interventions were obtained through medical records review. Statistical analysis was performed with Fisher's exact test for independent data and Student's t-test for comparison of group means. 310 consecutive patients (age 56 ± 16years, 48% female) were included in the study. In 265/310 (85%) patients, no routine follow-up imaging prior to catheter removal was obtained. In 2/265 (0.8%, 95% CI 0.02-0.27%) patients without routine pre-removal imaging, repeat abscess drainage was required 6 and 15days after catheter removal in patient with perforated appendicitis and after laparoscopic renal cyst decortication, respectively. No patients, 0/45 (0%, 95% CI 0-0.07), that underwent routine imaging without clinical or laboratory signs infection needed to undergo a repeat abscess drainage. There is a low rate (0.8%) of abscess recurrence if percutaneous abscess catheter is removed at the time cessation of drainage without routine imaging in clinically well patient.

A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses.

Computed tomography (CT) is commonly used to guide drainage of deep-seated abdominal fluid collections. However, in some cases, these collections seem to be inaccessible due to surrounding organs or their being in difficult locations. The aim of this study is to describe a modified Trocar technique to drain collections in difficult locations, especially those in the subphrenic space, without passing through intervening organs. This retrospective case series study describes seven inpatients who underwent CT-guided drainage using a modified Trocar technique for abscesses that are difficult to access percutaneously. All patients provided written informed consent prior to the procedure. After placement of a 12-14F catheter inside the peritoneum, the Trocar stylet was removed so that the tip of the catheter became blunt and flexible to avoid injury to organs and structures in the catheter route, and the catheter was slowly advanced towards the collection using CT guidance and tactile sensation. After reaching the target, the stylet was reintroduced to enter the abscess wall. All procedures were performed using an anterior abdominal wall access with adequate catheter positioning and resulted in clinical status improvement in the days after the drainage. No complications related to the procedure were identified in any of the patients. The modified Trocar technique for percutaneous CT-guided drainage of abdominal abscesses may be feasible for lesions that are difficult to access with conventional methods.

CT fluoroscopy-guided percutaneous drainage: comparison of the one step and the Seldinger techniques

Objective: To evaluate the one step technique compared with the Seldinger technique in computed tomography (CT) fluoroscopy-guided percutaneous drainage of abdominal and pelvic abscess.Material and methods: Seventy-six consecutive patients (49 men, 27 women; mean age 63.5 years, range 19–87 years) with abdominal and pelvic abscess were included in this study. Drainages were performed with the one step (n = 46) and with the Seldinger (n = 48) technique between September 2012 and June 2014.Results: The technical success and clinical success rates were 95.8% and 93.5%, respectively, for the one step group, and 97.8% and 95.7%, respectively, for the Seldinger group. The mean procedure time was significantly shorter with the one step than with the Seldinger method (15.0 ± 4.3 min, range 10–29 min vs. 21.0 ± 9.5 min, range 13–54 min, p < .01). The mean abscess size and depth were 73.4 ± 44.0 mm and 42.5 ± 19.3 mm, respectively, in the one step group, and 61.0 ± 22.8 mm and 35.0 ± 20.7 mm in the Seldinger group.Conclusion: The one step technique was easier and faster than the Seldinger technique. The effectiveness of both techniques was similar for the CT fluoroscopy-guided percutaneous drainage of abdominal and pelvic abscess.

Trends in Use of Percutaneous Versus Open Surgical Drainage of Abdominal Abscesses

PurposeTo compare recent trends in the use of percutaneous and surgical approaches to treating abdominal abscesses in a large population. MethodsThe nationwide Medicare Physician/Supplier Procedure Summary Master Files for 2001 through 2013 were searched. Current Procedural Terminology-4 codes were selected for the four types of abdominal abscesses that had distinct codes for both open surgical and percutaneous drainage—appendiceal, peritoneal, subphrenic, and liver. Medicare specialty codes were used to determine if the procedures were performed by radiologists or other nonradiologist physicians. Trends in use of the two approaches were compared. ResultsIn 2001, a total of 14,068 abdominal abscesses were drained percutaneously. This volume increased progressively every year thereafter, reaching 28,486 in 2013 (+102%). Open surgical drainage volume was 8,146 in 2001, decreasing progressively to 6,397 in 2013 (–21%). In 2001, 63% of all abdominal abscesses had been drained percutaneously; by 2013, this figure had risen to 82%. In 2001, radiologists had performed 90% of all percutaneous abdominal abscess drainages; this percentage share increased to 97% in 2013. Of all abdominal abscesses treated in 2013 in Medicare patients, 79% were treated by radiologists. ConclusionsUse of percutaneous drainage of abdominal abscesses has steadily increased, whereas use of open surgical drainage has declined. The vast majority of these abscesses are now treated percutaneously. Radiologists are a strong majority of those performing the procedures. Although this database does not provide information on outcomes, percutaneous drainage is another good example of radiology-related value.

Is Interval Appendectomy Indicated after Non-Operative Management of Acute Appendicitis in Patients with Cancer? A Retrospective Review from a Single Institution

Interval appendectomy (IA) is a controversial subject, with little consensus on its use in patients undergoing treatment for malignancy. We sought to determine the frequency of recurrent appendicitis in cancer patients managed nonoperatively (NOM) during index hospitalization (IHA) for acute appendicitis (AA). Clinical presentation, cancer treatment, and follow-up were collected from electronic medical records of patients with CT scan-confirmed AA treated at a single institution between August 1999 and August 2009. Seventy-two of 109 AA patients underwent appendectomy during IHA; 34 of these 109 were NOM during IHA. Median index length of NOM patients' stay was six days (0-55), median age was 59 (18-80) years. Indications for NOM were presence of abscess or phlegmon (14), mild symptoms (13), high surgical risk (3), end-stage cancer (3), and patient declining surgery (1). Eight NOM patients underwent percutaneous drainage of abdominal abscess (median total duration of intravenous + oral antibiotics = 12 days [0-55]). There were six deaths (1 IHA, 5 NOM): four sepsis and two cancer progression. At a median of 19-month follow-up (range 1-103), four NOM patients surviving IHA had recurrent AA (11.7%) at two (n = 2) and three months (n = 2) after the first episode. Overall, six had IA (17.6%) one to seven months post AA; 25 remained asymptomatic, without IA. In conclusion, among NOM patients at a cancer center at IHA for AA, recurrent AA was early (<4 months) but uncommon. IA should be offered to those with recurrent symptoms, but appears to have a very limited role after several months of asymptomatic follow-up.

Trauminio skrandžio plyšimo sepsinių komplikacijų gydymas minimaliai invaziniais metodais: klinikinis atvejis

ĮžangaIzoliuotas trauminis skrandžio plyšimas pasitaiko labai retai. Apie 95 % atvejų diagnozuojami gretutinių organų sužalojimai. Dėl santykinai palankios skrandžio anatomijos, jo mobilumo bei storos sienos skrandžio plyšimai sudaro 0,02–1,7 % visų bukų pilvo sužalojimų. Mūsų tikslas – aprašyti neįprastą trauminį skrandžio plyšimą, gydytą minimaliai invazinės chirurgijosmetodais.Atvejis62 metų vyras skubos tvarka hospitalizuotas į chirurgijos skyrių dėl skausmo epigastriumo srityje ir kraujavimo iš viršutinės virškinimo trakto dalies klinikinių požymių. Ligonis teigė, kad prieš 2 savaites patyrė buką pilvo traumą. Iš anamnezės žinoma apie skrandžio opaligę. Atlikus endoskopinį tyrimą rastas visą mažąją kreivę apimantis skrandžio išopėjimas be aktyvaus kraujavimo požymių. Pilvo organų echoskopijos duomenimis, konstatuota bursa omentalis skysčio sankaupa, priekinės pilvo sienos hematoma ir laisvas skystis pilvo ertmėje (apie 500–700 ml). Įtarta pridengta skrandžio kūno mažosios kreivės perforacija ir hemoperitoneumas. Ligoniui siūlytas skubus operacinis gydymas, bet jis tokio gydymo kategoriškai atsisakė. Konservatyvaus gydymo metu, atsiradus infekcijos požymių, atliktas pilvo organų ultragarsinis ir kompiuterinės tomografijos tyrimai, kuriais nustatyta bursa omentalis skysčio sankaupos ir priekinės pilvo sienos hematomos supūliavimas. Atliktas ultragarsu kontroliuojamas pilvo sienos hematomos dravimas 12 Fr drenu. Endoskopinės procedūros metu per užpakalinę skrandžio sieną drenuotas bursa omentalis pūlinys, į jo ertmę įkišus du 7 Fr drenus. Normalizavosi temperatūra, kraujo tyrimų rodikliai, pacientas pradėjo normaliai valgyti. Geros būklės išrašytas į namus 35 parą nuo hospitalizacijos pradžios. Stebėtas ambulatoriškai. Komplikacijų nekonstatuota. Po 2 mėnesių endoskopiškai pašalinti skrandžio drenai.IšvadaSkrandžio trauminio sužalojimo sepsinės komplikacijos gali būti efektyviai gydomos minimaliai invazinės chirurgijos priemonėmis – perkutaniniu ir endoskopiniu transgastriniu pūlinių drenavimu.

Percutaneous Drainage of Abdominal and Pelvic Abscesses in Children

It has only been in the last several decades that abscesses within deep compartments, particularly within the abdomen and pelvis, have become safely accessible with imaging guidance. Since that time, percutaneous abscess drainage has become the standard of care in children. We review the clinical features, diagnosis, and image-guided management of abdominal and pelvic abscesses in children.

Percutaneous, computed tomography-guided drainage of deep pelvic abscesses via a transgluteal approach: a report on 30 cases and a review of the literature

Percutaneous drainage of abdominal and pelvic abscesses is a first-line alternative to surgery. Anterior and lateral approaches are limited by the presence of obstacles, such as the pelvic bones, bowel, bladder, and iliac vessels. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous, transgluteal approach by reviewing our clinical experience and the literature. We reviewed demographic, clinical and morphological data in the medical records of 30 patients having undergone percutaneous, computed tomography (CT)-guided, transgluteal drainage. In particular, we studied the duration of catheter drainage, the types of microorganisms in biological fluid cultures, complications related to procedures and the patient's short-term treatment outcome. From January 2005 to October 2011, 345 patients underwent CT-guided percutaneous drainage of pelvis abscesses in our institution. A transgluteal approach was adopted in 30 cases (10 women and 20 men; mean age: 52.6 [range 14-88]). The fluid collections were related to post-operative complications in 26 patients (86.7 %) and inflammatory or infectious intra-abdominal disease in the remaining 4 patients (acute diverticulitis: n = 2; appendicitis: n = 1; Crohn's disease: n = 1) (13.3 %). The mean duration of drainage was 8.7 days (range 3-33). Laboratory cultures were positive in 27 patients (90 %) and Escherichia coli was the most frequently present microorganism (in 77.8 % of the positive samples). A transpiriformis approach (n = 5) was more frequently associated with immediate procedural pain (n = 3). No major complications were observed, either during or after the transgluteal procedure. Drainage was successful in 29 patients (96.7 %). One patient died from massive, acute cerebral stroke 14 days after drainage. When an anterior approach is unfeasible, transgluteal, percutaneous, CT-guided drainage is a safe, well tolerated and effective procedure. Major complications are rare. This type of drainage is an alternative to surgery for the treatment of deep pelvic abscesses (especially for post-surgical collections).

Drainage of Post-Operative Abdominal and Pelvic Abscesses Under the Guidance of Computed Tomography

BACKGROUND: Cross sectional imaging and specifically computed tomography (CT) has become the main radiological modality of detecting post-surgical abdominal collections and abscesses. Percutaneous abscess drainage (PAD) has revolutionized the treatment of abscesses, especially of post-surgical abdominal abscesses over the last 25 years; repeat laparotomy is a rare event due to the fact that the success rate of PAD is very high (90-95%) and complications are few (0-10%). OBJECTIVE: The aim of the study is to present our experience in the department of computed tomography of the percutaneous drainage of post-operative abdominal and pelvic abscesses. PATIENTS AND METHODS: During the last two and a half years, 93 post-operative patients were referred to the CT department for drainage of a post-surgical abscess in the abdomen or pelvis at 9-21 days post-operatively due to persistent fever. A total of 95 abscesses were drained; 84 were located in the abdomen and 11 in the pelvis. Abscess diameters ranged between 2 and 12 cm. A percutaneous drainage technique under CT-guidance was employed in all patients; 98 catheters were placed with use of the Seldinger technique. A transgluteal paracoccygeal approach was adopted in 11 patients. Aspiration of an intra-loop abscess was performed in 1 patient. The tilted gantry technique was utilized in 2 cases. RESULTS: Eighty-nine (95.7%) patients were successfully treated. In 4 (4.3%) patients the abscesses were partially drained, patients were stabilized and subsequently treated via laparotomy. Complications included inflammation of the skin at the entry site in 4 patients, pneumothorax in 1 patient, and displacement of the catheter in 12 patients, one involving catheter migration into the duodenum. Major complications did not occur. CONCLUSION: Percutaneous drainage of post-operative abdominal and pelvic abscesses was a safe and effective method of abscess management in our series with a 95.7% success rate and absent major complications. It is currently a widely used procedure, eliminating the need for repeat laparotomy in the majority of patients. Proper catheter management is essential for the successful outcome.

CT-Guided Drainage of Abdominal Abscesses: Hydrodissection to Create Access Routes for Percutaneous Drainage

The purpose of this article is to determine the clinical effectiveness of CT-guided injection of 0.9% saline solution into the retroperitoneal space to create access routes for imaging-guided percutaneous abscess drainage. Between January 2005 and December 2008, a radiology database was searched to identify patients who underwent CT-guided percutaneous drainage of abdominal abscesses using injection of 0.9% saline solution into the retroperitoneal space to displace vital structures and create access routes for percutaneous drainage. Patient sex and age and the cause, size, and location of the abscess were recorded. The volume of 0.9% saline solution used to displace the structures was recorded. Technical success of creating an access route and procedural success in completing percutaneous drainage were evaluated. Complications were recorded. Twelve patients (three men and nine women; mean age, 57 years; range, 26-84 years) with 12 abscesses underwent CT-guided percutaneous abscess drainage after injection of 0.9% saline solution into the retroperitoneum to displace structures and create an access route for drainage. The structures displaced using this technique included the ascending colon (n = 4), descending colon (n = 3), sigmoid colon (n = 2), duodenum (n = 2), and stomach (n = 1). The mean volume of 0.9% saline solution used to displace vital structures was 225 mL (range, 60-250 mL). Technical success was achieved in all 12 cases (100%). Procedural success was achieved in 11 (92%) of 12 cases. CT-guided injection of 0.9% saline solution into the retroperitoneal space is associated with a high technical success rate for displacing vital structures and creating a percutaneous access route for imaging-guided drainage of abdominal abscesses.

Management of Abdominal and Pelvic Abscesses That Persist Despite Satisfactory Percutaneous Drainage Catheter Placement

The purposes of this study were to determine the frequency with which percutaneous abdominopelvic abscess drainage catheters must be replaced because of inadequate drainage, to assess the effect of percutaneous catheter exchange on clinical outcome, and to determine the predictors of clinical success after catheter exchange. A database of interventional radiology procedures performed at a single tertiary care hospital from 2001 to 2006 was searched to identify the cases of patients who underwent percutaneous catheter drainage of abdominal or pelvic abscesses that was followed by exchange of the drainage catheter at a later date. The electronic medical records and imaging studies of these patients were retrospectively reviewed to determine the abscess characteristics, details of drainage catheter manipulation, and clinical outcome. Among the 3,027 percutaneous abscess drainage catheters placed, 82 were exchanged because of lack of improvement (imaging evidence of undrained fluid and persistent fever and leukocytosis), for an overall frequency of catheter exchange of 2.7% of abscesses in 3.7% of patients. The success rate of catheter replacement, defined as resolution of the fluid collection without open surgical drainage, was 76.8% (63/82). Prognostic factors favorably influencing the clinical success of catheter exchange included a larger number of drainage catheter sideholes, absence of a fistula, low residual abscess volume after initial catheter drainage, and low CT attenuation of abscess fluid. In cases of persistent abscess despite adequate catheter placement, percutaneous catheter exchange over a wire is useful for salvage after the large majority of primary failures. In addition, performance of CT and fluoroscopic catheter injection before catheter exchange facilitates recognition of the predictors of a likely response to catheter exchange.

Percutaneous Abdominal Abscess Drainage: A Historical Perspective

AJR:191, September 2008 introduced with a trocar technique after a positive preliminary aspiration. Given that this was early in their experience, the results were encouraging. Of nine attempted aspira­ tions using methods 1 and 2, eight were reported successful. Method 3 was attempted twice and was successful in one case. More im portant, there were no complications other than the aspiration failures. Haaga and colleagues [2] accurately concluded that CT is an excellent diagnostic and guidance tool for the percutaneous treatment of abdominal fluid collections. They recognized that CT, despite its ability to show gas and the extraluminal nature of the collection, is somewhat limited in its ability to fully characterize the fluid. Finally, they suggested that for definitive drainage the abscess must be superficial to avoid undesired peritoneal contamination and injury to adjacent structures. In short, the seed had been planted for percutaneous CT­ guided drainage procedures. Two years later, Gerzof and associates [3] reported their experience with percutaneous drainage procedures using both sonographic and CT guidance. In this study, they reviewed their experience in 23 patients in whom they used one of two drainage techniques: Seldinger (over guidewire)—with delivery of an 8­French angiographic pigtail catheter for drainage and trocar—with placement of 12­ or 16­French Argyle­Ingram catheters. They used sonographic guidance in 20 of 24 cases and CT guidance in the remaining four cases. The catheters were kept in place an average of 14 days in 22 patients, and only one patient required an open operation after failure of percutaneous drainage. Gerzof and associates [3] reported two major complications—one empyema and one hemorrhage—as well as three minor complications—chills, fever, and cutaneous sinus tract. Similar to the Haaga et al. [2] Percutaneous Abdominal Abscess Drainage: A Historical Perspective

Preoperative Optimization of Crohn's Disease

Patients with Crohn's disease often present to the surgeon for operative intervention in poor overall condition. They may be taking multiple immunomodulators to attempt to manage their disease, may have significant weight loss and evidence of malnutrition, and 10 to 30% of the time will have intraabdominal sepsis in the form of an abscess or fistula. Preoperative optimization of these patients, when possible, may decrease morbidity and mortality, and may avoid formation of stomas for fecal diversion. Enhancing nutritional status and streamlining immunomodulator therapy prior to surgery may improve outcomes. Medical management of intraabdominal sepsis with percutaneous drainage of abdominal or pelvic abscesses may decrease postoperative septic complications, and may even avert the need for surgical intervention altogether.

Percutaneous Drainage of Abdominal Abscesses in Pediatric Crohn's Disease

Crohn's disease is complicated by abscesses in 10-30% of patients during their lifetime. The goal of our study was to illustrate that, besides surgical treatment, percutaneous abscess drainage plays a major role in treating children with Crohn's disease. This retrospective study included 14 pediatric patients (age range, 12-17 years; median age, 15 years) with proven Crohn's disease. Percutaneous abscess drainage was performed for 15 abdominal or pelvic abscesses or for both abdominal and pelvic abscesses. The abscess was an initial manifestation of Crohn's disease in four patients and complicated well-known disease in 10 patients. Abscesses occurred spontaneously (n = 11), after surgery (n = 3), or after infliximab treatment (n = 1). Their volume ranged from 8 to 442 mL (mean, 113 mL). Fistulas with the bowel were detected in eight cases. Sixteen percutaneous abscess drainages were performed under sonographic or CT guidance (or both) using 6- or 8-French catheters. The procedure was performed with the patient under conscious sedation (n = 14) or anesthesia (n = 2). The duration of the drainage was 1-30 days (mean, 11 days). An enterocutaneous fistula, medically treated with success, was the only complication observed. Complete resolution of the collection was observed in eight abscesses and partial resolution in seven. Resection of the diseased bowel segment with primary anastomosis was possible in 12 patients. In two patients, percutaneous abscess drainage was not followed by surgery. Percutaneous abscess drainage is a valuable procedure in pediatric patients with Crohn's disease presenting with pelvic or abdominal abscesses (or both). It improves the general status of the patient and allows a less invasive and easier subsequent surgical procedure. Percutaneous abscess drainage should be performed before definitive treatment.

Outcome of Surgical Versus Percutaneous Drainage of Abdominal and Pelvic Abscesses in Crohn's Disease

Abdominal and pelvic abscesses are a common complication of Crohn's disease. We studied the effect of the initial choice of therapy on time to resolution of abdominal and pelvic abscesses. We recorded clinical, laboratory, and radiographic data on all adult patients with Crohn's disease and abdominal or pelvic abscesses treated at our institution from 1991 to 2001 and followed > or = 1 yr. Univariate analysis identified variables associated with initial choice of drainage modality. These variables were included in a Cox regression model to identify factors independently associated with time to resolution. Of 66 episodes identified, surgery was the initial modality in 29 and percutaneous drainage in 37. Median time to resolution was not different between surgical drainage (25.0 days, range 0-240) and percutaneous drainage (21.5 days, range 0-182) (p = 0.084). Older age, longer duration of symptoms prior to drainage, no fistula identified radiographically, immune modulator use, no rebound tenderness, and admission to the medical service were factors associated with percutaneous drainage as initial modality. These factors, when incorporated in a Cox regression model, did not significantly affect the time to resolution. Days from onset of symptoms to radiographic diagnosis or drainage were independently associated with time to resolution of the abscess. Time to resolution of abdominal or pelvic abscesses in Crohn's disease is similar with percutaneous drainage and surgery. One-third of patients treated with percutaneous drainage required surgery within 1 yr. Earlier intervention for abdominal and pelvic abscesses is associated with shorter time to resolution.

1261: Unconventional interventional ultrasound

Routine interventional ultrasound has been widely used in clinical work. For example, ultrasound-guided percutaneous drainage of abdominal cyst and abscess has primarily replaced traditional surgical therapy characterized by minimally invasiveness, sound curative effects and unexpensiveness. In recent years, ultrasound-guided ablation therapy for solid tumors has developed rapidly. Thermal ablation therapies, especially radiofrequency, microwave, laser and high intensive focus ultrasound (HIFU), have achieved inspiring results.

Percutaneous Drainage of Postoperative Abdominal Abscess with Limited Accessibility: Preexisting Surgical Drains as Alternative Access Route

To retrospectively assess the effectiveness and safety of postoperative percutaneous drainage of abdominal abscesses with limited accessibility by using a preexisting surgical drain as an access route. The study was approved by the institutional review board, and informed consent was not required. The authors reviewed the medical records of 92 patients (62 male, 30 female; median age, 59 years; age range, 3-79 years) with postoperative abdominal abscesses in whom percutaneous drainage was performed by using surgical drains as an access. Factors evaluated included the location and size of the lesion; time between surgery and the drainage procedure; distance between the lesion and surgical drain; presence of fistula; duration of drainage; type of surgical drain; size, type, and length of drainage catheter; and complications. Technical success was defined as adequate placement of a new drainage catheter into the target abscess. Midterm success was defined as avoidance of surgery or additional percutaneous drainage during the 6 months of follow-up. Univariate analysis and multiple logistic regression analysis were performed to determine factors that affected the technical or midterm success of the procedure. Of 92 postoperative abscesses for which the technique was attempted, 56 (61%) had a subphrenic location and 36 (39%) had a peripancreatic location. Technical success was achieved in 87 of the 92 patients (95%). Technical success was not significantly associated with any of the factors tested. Midterm success was achieved in 75 of the 87 patients (86%) in whom technical success was achieved. Midterm failure showed a statistically significant relationship with the presence of fistula (P = .04). No procedure-related complications were identified. Percutaneous drainage by using the surgical drain as an access route is an effective and safe alternative for draining postoperative abdominal abscesses that are less accessible with direct puncture..

Percutaneous Abdominal and Pelvic Abscess Drainage Techniques-Part I: Tools of the Trade

This review is a pictorial essay discussing the tools used in the image-guided percutaneous drainage of abdominal and pelvic abscesses. Topics covered include drainage catheters, access devices, directional catheters, dilators and sheaths, localizing devices, and fixation devices and drainage systems.