Percutaneous Drainage Of Abdominal Abscesses Research Articles

Abdominal abscess drainage under radiologic guidance: causes of failure.

The results of percutaneous drainage of abdominal abscesses in 136 patients are analyzed, revealing a failure rate of 23% (31 patients). The mortality rate was 1.4% (two patients); the rate of serious complications was 5% (seven patients). Failure rate was lowest in critically ill patients having palliative drainage only (12%), emphasizing the importance of immediate drainage to stabilize such patients. The low mortality rate is also attributed to prompt palliative drainage. Technical errors were most commonly responsible for failure of procedures (14%), especially failure to recognize and respond to loculation or subseptation, premature withdrawal of drains (12 patients), and inappropriate approach to the abscess (nine patients). Assignment of patients to a clinical interventional radiology service for the duration of this treatment may greatly facilitate management.

Percutaneous Drainage of Abdominal Abscess

Percutaneous Drainage of Abdominal Abscess

Percutaneous abdominal abscess drainage

Percutaneous abdominal abscess drainage

Special Problems in the Diagnosis and Treatment of Surgical Sepsis

Since sepsis is the most frequent single cause of death after surgery and trauma, its development should be anticipated in elderly patients or those with disease or trauma causing intestinal leaks, particularly if the patient had massive transfusions or was in shock. Diagnosis may be extremely difficult, particularly if the infection is intraperitoneal. Furthermore, patients with impaired host defenses may show only a failure to thrive and then a progressive MOF. Physical examination is usually not very helpful. Gallium and indium scans and ultrasonography are only about 50 to 60 per cent accurate. Ultrasonography followed by HIDA and PIPIDA scans may be very useful in diagnosing acute acalculous cholecystitis, which appears to be an increasingly frequent problem in these patients. Computerized tomographic scans are at least 80 to 90 per cent accurate in diagnosing intra-abdominal abscesses, but the diagnosis of peritonitis is still largely clinically based. Even without clear evidence of infection, the critically ill patient with MOF and previous abdominal trauma, surgery, or disease should probably have the abdomen explored (that is, a blind laparotomy). If generalized peritonitis is found, it may be wise to leave the abdomen open and re-explore and débride it daily until it is clean. Percutaneous drainage of abdominal abscesses is being performed increasingly and is of special value in the 30 to 50 per cent of patients with single bacterial abscesses in which the drainage tract does not cross bowel or peritoneum and there is no underlying intestinal leak. Antibiotics are only a second line of defense, and their use should be directed by smear and culture results when possible. For abdominal infections, coverage for gram-negative anaerobes and Bacteroides fragilis is essential. If the infection persists for more than 2 to 3 weeks, infection by enterococci and fungi must be considered. If shock develops, maintaining an O2 consumption of at least 130 to 160 ml per minute per m2 is a particularly important part of the resuscitation. Although controversial, raising the hematocrit to 40 to 45 per cent or higher is often of value.

Outpatient therapy of intra-abdominal abscesses following early discharge from the hospital.

Although percutaneous aspiration and drainage of abdominal abscesses will frequently avert an open surgical procedure, patients remain hospitalized during drainage. The authors treated 9 patients for abscesses using percutaneous drainage catheters and sent them home with the catheter in place. All had an uneventful recovery. An average of $12,050 was saved in each case. The authors suggest that outpatient drainage of abdominal abscesses is significantly less expensive than inpatient treatment, yet does not jeopardize patient care.

Percutaneous drainage of abscesses in the postoperative abdomen that is difficult to explore

We have evaluated our experience with computerized tomography and ultrasonography guided percutaneous drainage of extrahepatic abdominal fluid collections in a group of 22 patients. The most common goal was to avoid or delay surgery on abdomens in which reoperation would be difficult, mainly in high-risk patients. Drainage of pancreatic fluid collections or abscesses was also attempted in a small number of the patients. Percutaneous drainage was curative in 69 percent of those with nonpancreatic abscesses but in only 33 percent of those with abscesses associated with the pancreas. There were no complications attributable to the procedure or to delays in subsequent surgical drainage. Two patients died from problems not directly related to the use of percutaneous drainage. Percutaneous catheter drainage of nonpancreatic abdominal abscesses can play a useful role in patients who are carefully selected because they possess a complex abdominal anatomy distorted by previous surgery and infection or they are at high risk if surgical exploration is carried out.

10 - Diagnosis and Percutaneous Drainage of Abdominal Abscesses

10 - Diagnosis and Percutaneous Drainage of Abdominal Abscesses

Radiologic Aspects of Diagnosis and Treatment of Abdominal Abscesses

The precise anatomic display by computed tomography and ultrasonography provides the guidance to make diagnostic needle aspiration a safe routine procedure. Percutaneous catheter drainage of abdominal abscesses now offers an alternative to surgery and has already become a well-established radiologic procedure in many centers.

Percutaneous abdominal abscess drainage: Portland area experience

After reviewing 21 patients who have had percutaneous abdominal abscess drainage, we believe that the procedure should be considered for those abscesses that are unilocular without septations, with safe access being a key variable dictating the use of percutaneous abdominal abscess drainage rather than surgery. A computerized tomographic scan of the abdomen should be employed at some stage of the percutaneous abdominal abscess drainage procedure to facilitate safe access to the abscess and to distinguish a synchronous abscess where present. In addition, we believe that percutaneous abdominal abscess drainage should be considered for postsurgical abscesses only and not those that are spontaneous in nature or where the original abnormality cannot be accurately surmised. With regard to catheter management, frequent irrigation of the catheter must be carried out at least every 4 to 6 hours, with high levels of antibiotics present in the blood before irrigation. This must be done to obviate the most frequent and potentially lethal complication of the procedure, namely sepsis. Percutaneous abdominal abscess drainage, although safe for the most part, is capable of inducing considerable morbidity. Our data suggest that percutaneous abdominal abscess drainage is not as efficacious as previous reports have suggested. Traditional surgical drainage techniques are best utilized for those abscesses that are multiple, highly viscous, inaccessible, spontaneous, or unresponsive to percutaneous abdominal abscess drainage.

Computed tomographic guidance of percutaneous needle aspiration and drainage of abdominal abscess

Percutaneous thin needle aspiration biopsy (TNAB) of solid abdominal masses is an established technique. Combining the techniques of TNAB with those of percutaneous biliary and renal drainage can result in successful nonoperative management of abdominal abscesses. Twenty consecutive patients were referred for this procedure. TNAB alone was performed in 4 patients. TNAB followed by percutaneous drainage was accomplished in 16 patients. Of the 4 patients who had TNAB alone, it was curative in 2, and 2 were elected to have surgical drainage. Of the 16 patients who underwent percutaneous drainage, it was curative in 14. One patient was discovered at surgery to have a necrotic malignant tumor. A second patient required surgery.

Percutaneous Catheter Drainage of Abdominal Abscesses. A Five-Year Experience

We used computed tomography (CT) and ultrasonography for detection and localization of intra-abdominal abscesses. On the basis of these images, safe routes for diagnostic aspiration and percutaneous drainage were planned. Over these routes indwelling catheters were inserted to provide immediate decompression, evacuation, and continuous drainage until the abscess resolved. All patients received concomitant intravenous antibiotics. The treatment was used for 71 abscesses in 67 patients. Sixty-one abscesses (86 per cent) were satisfactorily drained. There were 11 complications (15 per cent). Six deaths were attributable to sepsis, three of which (4 per cent) were related to inadequate drainage. There was one recurrence (1 per cent) during a follow-up period ranging from one month to five years (means, 22.3 months). The mean duration of treatment was 20.2 days (range, five to 120 days). We conclude that percutaneous drainage is an effective method for treatment of abdominal abscesses and is indicated when sectional imaging demonstrates an accessible unilocular lesion.

Computed tomography-guided percutaneous drainage of right upper abdominal abscesses.

Definitive computed tomography-guided percutaneous drainage of right upper abdominal abscesses was performed in eight patients (11 procedures). A lateral perpendicular approach was used in all cases. An Argyl trocar catheter was used in nine procedures and a pigtail catheter in two. The drainage was successful in seven patients. In one patient no drainable abscess was found. Percutaneous abdominal abscess drainage should be considered a satisfactory alternative to surgical drainage in poor-risk patients as well as in patients who have had repeated operations in whom any further surgery may be unduly difficult.

Percutaneous catheter drainage of abdominal abscesses: a five-year experience.

We used computed tomography (CT) and ultrasonography for detection and localization of intra-abdominal abscesses. On the basis of these images, safe routes for diagnostic aspiration and percutaneous drainage were planned. Over these routes indwelling catheters were inserted to provide immediate decompression, evacuation, and continuous drainage until the abscess resolved. All patients received concomitant intravenous antibiotics. The treatment was used for 71 abscesses in 67 patients. Sixty-one abscesses (86 per cent) were satisfactorily drained. There were 11 complications (15 per cent). Six deaths were attributable to sepsis, three of which (4 per cent) were related to inadequate drainage. There was one recurrence (1 per cent) during a follow-up period ranging from one month to five years (means, 22.3 months). The mean duration of treatment was 20.2 days (range, five to 120 days). We conclude that percutaneous drainage is an effective method for treatment of abdominal abscesses and is indicated when sectional imaging demonstrates an accessible unilocular lesion.

Percutaneous drainage of deep abdominal abscesses

Percutaneous drainage of deep abdominal abscesses