Percutaneous Abscess Drainage Research Articles

Simultaneous prostatic and right seminal vesicle abscesses: a case report

BackgroundSynchronous abscesses of the prostate and seminal vesicles represent a rare but clinically significant form of purulent retention. They pose diagnostic and therapeutic challenges and are associated with considerable morbidity and a high risk of sepsis.Case presentationWe present the case of a 60-year-old Caucasian man with a history of insulin-dependent diabetes mellitus, who had a voluminous prostatic abscess associated with a right seminal vesicle abscess due to compression of the right ejaculatory duct, and who presented to our department with sepsis. He had clinical and radiological confirmation with computed tomography scan and magnetic resonance imaging. The patient underwent percutaneous drainage of the prostatic abscess resulting in the subsidence of the seminal vesicle abscess. The treatment also consisted on prolonged antibiotic therapy. The clinical evolution was favorable.ConclusionWe conclude that prostatic abscesses can lead to synchronous seminal vesicle abscesses due to ejaculatory duct compression. Percutaneous drainage of the prostatic abscess by transrectal ultrasound-guided drainage, combined with prolonged antibiotic therapy, can effectively treat both abscesses.

Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta-analysis with trial sequential analysis of randomized trials.

Fibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta-analysis evaluates their efficacy. We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing FA and saline in percutaneous drainage of abdominal abscesses. Outcomes included length of hospitalization, duration of drainage, and drainage volume. We pooled mean differences (MD) and 95% confidence intervals (CI) using a random-effects model. We also performed a trial sequential analysis (TSA). We included six RCTs encompassing 299 patients. In the overall analysis, FA increased drainage volume (MD 104.25mL; 95% CI 35.72-172.77mL; p=0.003; I2=0%). In children, saline reduced hospitalization duration (MD -1.26days; 95% CI -1.98 to -0.55days; p=0.0006; I2=0%), whereas FA increased drainage volume (MD 84.66mL; 95% CI 5.77-153.54mL; p=0.04; I2=0%). In adults, FA significantly reduced hospitalization duration (MD -11.12days; 95% CI -15.16 to -7.08days; p<0.00001; I2=0%) and duration of drainage (MD -6.53days; 95% CI -9.25 to -3.81days; p<0.00001; I2=0%) while increasing drainage volume (MD 164.47mL; 95% CI 26.16-302.78mL; p=0.02; I2=0%). On TSA, the required information size was achieved only for the adult subgroup's hospitalization and drainage duration. In adults, FA reduce hospitalization and drainage duration and increase drainage volume. In children, saline seems more effective in reducing hospitalization duration, while FA increase drainage volume. These findings underscore the need for age-specific treatments and further research, especially in the pediatric population.

The association between patient age, abscess size, and white blood cell count on duration of catheter stay for percutaneous abscess drainage of abdominal abscesses

ObjectiveKnowing factors that impact catheter stay duration is important since removing drainage catheters too early or late can have significant consequences. We present a single center retrospective study that analyzes multiple variables, including abscess size, white blood cell count, and patient age, to see if a correlation between them and duration of catheter stay exists. The inclusion criteria were patients that had abdominal abscesses treated with percutaneous abscess drainage using a pigtail catheter, ≥ 18 years of age, and had available medical images and records. 44 patients were included.ResultsAmong white blood cell count, patient age, and abscess volume, the only significant relationship with duration of catheter stay was abscess size (R = 0.42, p-value = 0.0049).

SP2.1 - Endoscopic retrograde appendicitis therapy for peri-appendiceal abscess

Abstract Aims ERAT is a novel technique primarily for uncomplicated appendicitis, but it is starting to be used also for peri-appendiceal abscesses. The aim of this study was to evaluate the efficacy and clinical outcomes of ERAT in treating patients with peri-appendiceal abscess. Methods Between January 2018 and April 2023, twenty-eight patients with peri-appendiceal abscess were treated with ERAT. We retrospectively analyzed the location and size of the peri-appendiceal abscess, success rate of ERAT, median operative time, postoperative hospital stay and complications. We defined success of ERAT as finding the appendiceal orifice and successful performance of ERAT without conversion to appendectomy or percutaneous drainage of the appendiceal abscess within one month. All patients were followed up at least 6 months, with a median follow-up of 31.5 months. Results The success rate of ERAT was 75.0% (95% CI, 54.8%-88.6%; n = 21/28). 35.7% (95% CI, 19.3%-55.9%; n = 10/28) of peri-appendiceal abscesses were located in the lower ileum, and the median size of appendiceal abscesses was 43.5 mm (95% CI: 33-53). 80.8% (95% CI, 60.0%-92.7%; n = 21/26) of patients had a visual analogue scale pain score of ≤3 at 24 hours after treatment. The median procedure time was 69.5 minutes (95% CI: 51-76), and the median hospital stay was 6.5 days (95% CI: 5-9). During the follow-up period, a total of four (17.1%; 95% CI, 0.9%-13.1%; 4/21) patients presented with abdominal pain associated with peri-appendiceal abscesses. Conclusions ERAT is a technically feasible treatment for peri-appendiceal abscesses.

Percutaneous Drainage Of Pyogenic Liver Abscess: A Case Series

Percutaneous Drainage Of Pyogenic Liver Abscess: A Case Series

Clinical characteristics and management of liver abscess in The Gambia, a resource-limited country

Liver abscess is endemic in resource-limited countries such as The Gambia where access to advanced imaging techniques or modern treatment modalities is limited. Despite this, mortality in this cohort was low. Therefore antibiotic therapy combined with percutaneous abscess drainage remains a reasonable treatment strategy of liver abscess in resource-poor settings.

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.

Complicated Appendicitis: An Update on Management: Mini Review

Complicated appendicitis is a complication of acute appendicitis, which is defined as perforation of the appendix, with abscess or mass formation. The management of complicated appendicitis was initially with conservative treatment with intra-venous antibiotics, with percutaneous drainage of abscess reserved for patients with abscess formation. The recent trend has seen a movement towards immediate appendectomy with laparoscopic appendectomy being the preferred surgical option. As there is no definitive consensus on the management of complicated appendicitis, we have conducted this mini review to look at the treatment option for complicated appendicitis in adults and children.

Tsukamurella Bacteremia in a Surgical Patient: Case Report and Review of the Literature.

Background: Tsukamurella species were first isolated in 1941. Since then, 48 cases of Tsukamurella bacteremia have been reported, a majority of which were immunosuppressed patients with central venous catheters.A case is described and previous cases of Tsukamurella bacteremia are reviewed. Patients and Methods: A 70-year-old total parenteral nutrition (TPN)-dependent female with recurrent enterocutaneous fistula (ECF), developed leukocytosis one week after a challenging ECF takedown. After starting broad-spectrum antibiotic agents, undergoing percutaneous drainage of intra-abdominal abscess, and subsequent repositioning of the drain, her leukocytosis resolved. Blood and peripherally inserted central catheter (PICC) cultures grew Tsukamurella spp. The patient was discharged to home with 14 days of daily 2 g ceftriaxone, with resolution of bacteremia. Conclusions: Tsukamurella spp. are a rare opportunistic pathogen predominantly affecting immunocompromised patients, with central venous catheters present in most cases. However, there have been few reported cases in immunocompetent individuals with predisposing conditions such as end-stage renal disease and uncontrolled diabetes mellitus.

Percutaneous Drainage of Pediatric Pulmonary Abscesses: An Effective Therapy

IntroductionPulmonary abscess is a complication of lung infection with localized necrosis and purulent cavity formation. Pulmonary abscesses are typically managed using antibiotic therapy with anatomic surgical resection reserved as a rescue. Percutaneous drainage is considered relatively contraindicated in some centers due to perceived risk of bronchopleural fistula. However, drain placement has been frequently employed at our institution. The purpose of this study was to review and describe our longitudinal experience. MethodsMedical records of children diagnosed with lung abscess and treated with percutaneous drainage from 2005 through 2023 were reviewed. Patient clinical parameters, follow-up imaging, and clinical outcomes were evaluated. ResultsPercutaneous drainage (n = 24) or aspiration alone (n = 4) under imaging guidance was performed by interventional radiologists for 28 children with lung abscesses. A single catheter (8–12 Fr) was deployed in the pulmonary abscess cavity and remained for a median of 6 days (IQR: 6–8 days). The median hospital stay was 10 days (IQR: 8.8–14.8 days). The technical success rate for percutaneous drainage or aspiration of primary pulmonary abscesses was 100% (26/26). Two children were later diagnosed with secondarily infected congenital pulmonary airway malformations that were both successfully drained and ultimately surgically resected. The abscess cavities resolved in all patients and catheters were removed upon clinical, radiographic, and laboratory improvement. Complications included the presence of two bronchopleural fistula, both of which were treated with immediate pleural drain placement. ConclusionPercutaneous drainage of pulmonary abscesses is an effective therapeutic option in children and can be considered alongside antibiotics as part of the initial treatment for pulmonary abscesses. Bronchopleural fistula can occur, but at a lower frequency than previously reported. Level of EvidenceLevel V.

Methylene blue photodynamic therapy of deep tissue abscesses: Phase 1 clinical trial and optical spectroscopy results

SignificanceDeep tissue abscesses represent a significant source of morbidity and hospital stay, with standard of care drainage failing in many cases. We investigated photodynamic therapy (PDT) as an adjunct to standard of care, to reduce or eliminate bacterial burden. ApproachA Phase 1 clinical trial was performed to evaluate safety and feasibility of methylene blue (MB) PDT at the time of abscess drainage. Immediately following drainage, MB-PDT was performed. Diffuse reflectance spectroscopy was performed to evaluate abscess wall optical properties. ResultsNo study-related adverse events were noted, and no side effects were observed. PDT was well tolerated by all subjects, and infused MB was recovered in all cases. Optical property measurements showed variability in hemoglobin concentration and oxygenation, as well as MB uptake, between subjects. ConclusionsMB-PDT at the time of percutaneous abscess drainage was safe and feasible, and optical property measurements showed wide variance between subjects.

Klebsiella pneumoniae-related rare multi-site infections: A case series

The incidence of Klebsiella pneumoniae (KP)-related rare multi-site infections has been progressively rising in China, highlighting the need for heightened awareness of the devastating complications associated with metastatic infections caused by this bacterium. This article describes the cases of six adult patients diagnosed with KP-related multi-site infections at a tertiary hospital in China from 2020 to 2022. The cases report a detailed examination of clinical features, laboratory test findings, bacterial culture results, imaging examinations, treatments administered, and subsequent outcomes. Notably, metastatic infections developed in four patients with uncontrolled diabetes. Despite strict glycemic control and timely antibiotic administration in three patients, their conditions deteriorated rapidly. The unfavorable prognosis in these patients may be attributed to delayed medical intervention, inadequate diabetes control, and unattended abscesses. The findings of this case series underscore the importance of glycemic control, percutaneous abscess drainage, and appropriate antibiotic selection in managing KP infections. Attaining early diagnosis and treatment of KP-related multi-site infections could potentially enhance patient outcomes.

Complicated Appendicitis in Children: Current Management. Review Article

Complicated appendicitis in children is a challenging condition to treat and the treatment options that are available include conservative treatment followed by interval appendectomy and immediate appendectomy. Both these treatment options are effective but as there is no consensus on the management of complicated appendicitis, the treatment option is often decided by the treating surgeon. We have conducted this review article to look at the treatment options that are available, from conservative treatment to immediate appendectomy. We have also looked at the role of percutaneous drainage of appendicular abscess and the role of interval appendectomy.

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.

Updated Review of Radiologic Imaging and Intervention for Acute Pancreatitis and Its Complications.

This is a current update on radiologic imaging and intervention of acute pancreatitis and its complications. In this review, we define the various complications of acute pancreatitis, discuss the imaging findings, as well as the timing of when these complications occur. The various classification and scoring systems of acute pancreatitis are summarized. Advantages and disadvantages of the 3 primary radiologic imaging modalities are compared. We then discuss radiologic interventions for acute pancreatitis. These include diagnostic aspiration as well as percutaneous catheter drainage of fluid collections, abscesses, pseudocysts, and necrosis. Recommendations for when these interventions should be considered, as well as situations in which they are contraindicated are discussed. Fortunately, acute pancreatitis usually is mild; however, serious complications occur in 20%, and admission of patients to the intensive care unit (ICU) occurs in over 10%. In this paper, we will focus on the imaging and interventional radiologic aspects for the serious complications and patients admitted to the ICU.

A Case Report of Disseminated Nocardiosis in a Patient with HIV Infection: Concurrent Liver, Pulmonary, and Brain Involvements

Introduction: Disseminated nocardiosis is a rare but life-threatening infectious disease that occurs most often in immunocompromised individuals. This report presents a human immunodeficiency virus (HIV)-infected patient with disseminated nocardiosis in the liver, lung, and brain. Case Presentation: A 38-year-old woman who had recently been diagnosed with HIV infection complained of fever, abdominal pain, productive coughs, and occasional headaches from 2 months ago. Imaging findings of her abdomen and lungs displayed evidence of pyogenic liver abscess and lobar pneumonia with abscess formation, respectively. The patient underwent percutaneous liver abscess drainage and bronchoalveolar lavage (BAL). Using reverse transcription-polymerase chain reaction (RT-PCR), the genome of Nocardia farcinica was detected in the specimens obtained from both procedures. Besides, she had seizures during hospitalization. Based on cerebrospinal fluid (CSF) analysis, the specimen was positive for N. farcinica. Brain imaging also revealed evidence of multiple bacterial abscess formation. She was diagnosed with disseminated nocardiosis and treated with intravenous imipenem, trimethoprim/sulfamethoxazole, and amikacin, followed by appropriate oral agents. After a 6-month follow-up, the patient had no symptoms. Additionally, the lesions improved on brain imaging. Conclusions: Patients who are HIV-positive are particularly prone to opportunistic infections. Health care providers should consider all pathogens, even rare ones, like Nocardia spp., to establish a diagnosis if they're present. Furthermore, in cases initially diagnosed with localized nocardiosis, other body organs should also be reviewed so that the disseminated form of the disease can be diagnosed and treated immediately.

Percutaneous drainage of liver abscess in three public hospitals in Paraguay

Percutaneous drainage of liver abscess in three public hospitals in Paraguay

Comment on "An Unusual Abscess Associated with Gallbladder Perforation Successfully Treated with Percutaneous Transhepatic Gallbladder Drainage and Endoscopic Ultrasound-guided Abscess Drainage".

Comment on "An Unusual Abscess Associated with Gallbladder Perforation Successfully Treated with Percutaneous Transhepatic Gallbladder Drainage and Endoscopic Ultrasound-guided Abscess Drainage".

Authors response: "An Unusual Abscess Associated with Gallbladder Perforation Successfully Treated with Percutaneous Transhepatic Gallbladder Drainage and Endoscopic Ultrasound-guided Abscess Drainage".

Authors response: "An Unusual Abscess Associated with Gallbladder Perforation Successfully Treated with Percutaneous Transhepatic Gallbladder Drainage and Endoscopic Ultrasound-guided Abscess Drainage".

Minimally invasive interventions for complications associated with intra-abdominal calculi after laparoscopic cholecystectomy

To study the possibilities of minimally invasive methods for removing intra-abdominal calculi after laparoscopic cholecystectomy. There were 5 patients with abdominal abscesses associated with infected calculi after previous laparoscopic cholecystectomy at the Sklifosovsky Research Institute for Emergency Care between 2020 and 2023. Mean age of patients was 55±12 years. There were 3 (60%) women and 2 (40%) men. All patients underwent minimally invasive treatment. Four patients (80%) underwent percutaneous drainage of abscess with subsequent replacement by larger drains and removal of calculi with endoscopic assistance. Event-free period after cholecystectomy was 44±32 months. One patient developed subhepatic abscess in 72 months after laparoscopic cholecystectomy. This patient underwent transluminal removal of calculus through the duodenal wall. There was 1 calculus in 3 (60%) patients, 2 calculi in 1 (20%) patient and 3 calculi in 1 (20%) patient. The above-mentioned cases demonstrate successful minimally invasive interventions for symptomatic abdominal calculi after laparoscopic cholecystectomy. Minimally invasive treatment can reduce surgical aggression and accelerate rehabilitation.