Percutaneous Abscess Drainage Research Articles

Percutaneous Ultrasound Guided Drainage of Abdominal Abscesses

Intraabdominal abscesses are common surgical pathologies that result from a myriad of causes and require a high index of suspicion to diagnose. Majority of the patient’s present critically ill requiring surgical drainage. The traditional open surgical drainage is associated with a high morbidity and mortality. Percutaneous ultrasound guided drainage which entails either needle aspirations or image guided catheter placements for a thick abscess is a suitable alternative to open surgical drainage. This study was aimed at evaluating our experience with ultrasound guided percutaneous drainage of intraabdominal abscesses in a Teaching hospital in north central Nigeria. Methodology Consecutive patients diagnosed to have intraperitoneal abscesses in a general surgery unit at Jos University Teaching Hospital over a 24 month period were studied. Results Twenty four patients were involved in this study. There were 14 males and ten females giving a male to female ratio (M: F =1.4:1). The mean age of the study population was 40+/- 19.3 with age range of 10-70years. Ten patients (41.7%) had abscesses in the liver, 6(25%) in the pelvis and 5(20.8%) were sub-phrenic in location, 3(12.5%) were psoas abscesses. Fifteen patients (62.5%) had their abscesses drained by needle aspiration while the remaining 9 (37.5%) were drained through placement of Foley’s catheters. There was no mortality in this study. In conclusion, percutaneous ultrasound guided drainage of abdominal abscesses is a viable alternative to open surgical drainage.

An Increasing Prominent Disease ofKlebsiella pneumoniaeLiver Abscess: Etiology, Diagnosis, and Treatment

Background. During the past two decades, Klebsiella pneumoniae (K. pneumoniae) had surpassed Escherichia coli (E. coli) as the predominant isolate from patients with pyogenic liver abscess (PLA) in Asian countries, the United States, and Europe, and it tended to spread globally. Since the clinical symptom is atypical, the accurate and effective diagnosis and treatment of K. pneumoniae liver abscesses (KLAs) are very necessary. Methods. Here, we have comprehensively clarified the epidemiology and pathogenesis of KLA, put emphases on the clinical presentations especially the characteristic radiographic findings of KLA, and thoroughly elucidated the most effective antibiotic strategy of KLA. Results. K1 serotype is strongly associated with KLA especially in diabetic patients. Computed tomography (CT) and ultrasound (US) were two main diagnostic methods of KLA in the past. Most of KLAs have solitary, septal lobular abscesses in the right lobe of liver, and they are mainly monomicrobial. Broad-spectrum antibiotics combined with the US-guided percutaneous drainage of liver abscesses can increase their survival rates, but surgical intervention still has its irreplaceable position. Conclusion. The imaging features contribute to the early diagnosis, and the percutaneous intervention combined with an aminoglycoside plus either an extended-spectrum betalactam or a second- or third-generation cephalosporin is a timely and effective treatment of KLA.

Emphysematous Liver Abscesses Complicated by Septic Pulmonary Emboli in Patients with Diabetes: Two Cases

An emphysematous liver abscess is a fatal condition that often occurs in patients with uncontrolled diabetes mellitus. I herein describe two cases of Klebsiella pneumoniae-induced emphysematous liver abscesses complicated by septic pulmonary emboli in patients with poorly controlled diabetes mellitus. Both patients showed hemoglobin A1c levels of more than 10% and did not present with any abdominal symptoms on admission. However, they were diagnosed and successfully treated with percutaneous transhepatic abscess drainage and antibiotics. This fatal disease should be taken into consideration in patients with uncontrolled diabetes mellitus who suffer from prolonged fevers and uncharacteristic general malaise.

Severe Tracheal Dislocation Secondary to Neck Abscess, Successfully Treated by Urgent Percutaneous Drainage

Abscesses and cellulitis represent the leading causes for emergency department visits and hospital admissions for intravenous drug addicts’ patients. Since these patients frequently use the neck for vascular access, neck abscesses are also commonly developed causing serious airway problems. A 28-year old Intravenous Drug Addict (IVDA) Caucasian male patient, presented to the casualty Department due to progressive neck swelling and pain after self-administered, unsterile, deep-cervical intravenous injection of heroin. Emergency contrast computed tomography scan revealed a large abscess causing significant dislocation of the trachea. The patient was urgently treated by percutaneous neck abscess drainage, via an 8Fr catheter, under ultrasound guidance Emergency computed tomography scan of the affected area and ultrasound scan of the major vascular supply are helpful in designing the therapeutic approach in terms of percutaneous drainage or surgery in cases of neck abscess that may cause airway obstruction in intravenous drug addicts. Percutaneous drainage under ultrasound guidance represents an effective treatment option relieving the life threatening trachea dislocation and eliminating the need for surgical intervention.

A Liver Abscess Deprived a Healthy Adult of Eyesight: Endogenous Endophthalmitis Associated with a Pyogenic Liver Abscess Caused by Serotype K1 <i> Klebsiella Pneumonia</i>

Klebsiella pneumonia usually causes urinary tract infections, pneumonia, and other infectious diseases in hospitalized and immunocompromised patients. Among the types of Klebsiella pneumonia, serotype K1 is known to be a highly virulent pathogen. We herein report the case of a healthy 63-year-old man with a pyogenic liver abscess and bilateral endogenous endophthalmitis caused by serotype K1 Klebsiella pneumonia. Although the patient received percutaneous abscess drainage and antibiotic therapy, he lost his eyesight. To improve the poor prognoses of ocular complications, providing both an earlier diagnosis and treatment is critical.

Approaches to the Difficult Drainage and Biopsy

Percutaneous abscess drainage and percutaneous biopsy are effective and widely used techniques in the diagnosis and treatment of patients with abdominal or pelvic abscesses and lesions. Some abscesses and lesions can initially appear unsuitable for percutaneous access for a variety of reasons. This article reviews the circumstances in which collections or lesions may appear undrainable or inaccessible to percutaneous biopsy, and it describes techniques for overcoming these circumstances.

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.

Klebsiella pneumoniae liver abscess: a new invasive syndrome

Klebsiella pneumoniae is a well known human nosocomial pathogen. Most community-acquired K pneumoniae infections cause pneumonia or urinary tract infections. During the past two decades, however, a distinct invasive syndrome that causes liver abscesses has been increasingly reported in Asia, and this syndrome is emerging as a global disease. In this Review, we summarise the clinical presentation and management as well the microbiological aspects of this invasive disease. Diabetes mellitus and two specific capsular types in the bacterium predispose a patient to the development of liver abscesses and the following metastatic complications: bacteraemia, meningitis, endophthalmitis, and necrotising fasciitis. For patients with this invasive syndrome, appropriate antimicrobial treatment combined with percutaneous drainage of liver abscesses increases their chances of survival. Rapid detection of the hypervirulent strain that causes this syndrome allows earlier diagnosis and treatment, thus minimising the occurrence of sequelae and improving clinical outcomes.

Management of Complicated Appendicitis in the Pediatric Population: When Surgery Doesn't Cut It

The management of complicated appendicitis in children has evolved significantly over the last century. What initially was a surgeon's dilemma is becoming the interventional radiologist's task because image-guided percutaneous drainage of abscesses from a ruptured appendix obviates the need for urgent surgery and allows for selective interval appendectomy at the surgeon's discretion (versus conservative nonoperative management in selected cases). This paradigm shift places the onus on the interventional radiologist to recognize when the procedure is emergently indicated and to be cognizant of the special needs of a pediatric patient.

A Case of Clostridium septicum Liver Abscess Associated with Malignancy

Purpose: A 53-year-old Caucasian man is brought to the emergency room after being found unresponsive at his group home. On arrival, he is hypotensive but regains consciousness after fluid resuscitation. He reports noticing increasing abdominal girth over past week, bloating, lower extremity swelling, weight loss, decreased appetite, several months of hematochezia and diarrhea. His medical history is limited to schizophrenia, since he lacks medical follow-up. On physical examination, he appears jaundiced, cachectic, and uncomfortable. His abdomen is soft but distended with significant hepatomegaly and liver edge extending 7 finger-breaths below the right costal margin. Rectal exam reveals fullness with brown guaiac positive stool. Other pertinent findings include temporal wasting, sclera icterus, dry mucus membranes, bilateral crackles and bilateral lower extremity pitting edema. On CT scan, the liver is enlarged, diffusely heterogeneous with multiple discrete masses. Several areas of gas and debris are present in the hepatic parenchyma. Rectosigmoid thickening is noted. He is placed on mechanical ventilatory support for hypoxic respiratory failure from septicemia. Antibiotic therapy with intravenous tigecycline and clindamycin is initiated. He underwent CT-guided percutaneous abscess drainage. The blood and abscess culture reveal Clostridium septicum, high CEA and Ca19-9 markers. He remained hypotensive requiring multiple agents for vasopressor support, and became hypothermic and anuric. Family withdrew care on the 5th day of hospital stay. Autopsy revealed a primary rectal adenocarcinoma with liver metastasis. Pyogenic liver abscess has been described since the time of Hippocrates (400 BC). The incidence of pyogenic liver abscess is estimated to be 8-15 cases per 100,000 persons. Fatalities can range from 3 to 30%. The risk factors associated with mortality have included age, bacteremia, and comorbities such as cirrhosis, renal failure and malignancy. Clostridium septicum is an anaerobic gram-positive spore forming bacillus. C. septicum sepsis is often fulminant with reported mortality rates of approximately 60%. A relationship between C. septicum infection and malignancy, especially hematologic or colonic malignancy has been suggested. One explanation as to why Clostridium infections are present in malignancy is that anaerobic glycolysis of the tumor provides a hypoxic and acidic environment that may be conducive to spore germination thus leading to infection. An early diagnosis is critical in choosing appropriate antibiotic and surgical intervention for treatment of C. septicum related sepsis.

Pyogenic liver abscess mimicking pleural effusion

Pyogenic liver abscess is a major visceral abscess that may pose a diagnostic dilemma in a febrile child with prominent extra-abdominal symptoms. We present a case of a well-nourished, immunocompetent four-year-old girl who had none of the common predispositions to a liver abscess. Hence, in this unusual setting, pyogenic liver abscess was not considered at the initial assessment, until closer evaluation and futile efforts to drain a seemingly large “pleural effusion” eventually revealed the diagnosis, which was confirmed by imaging. She underwent ultrasound-guided percutaneous drainage of the pyogenic liver abscess to avert the sequelae of this potentially fatal disorder. This underscores the need to think laterally when considering differential diagnoses for the sick child.

Effect of Resident Postgraduate Year on Outcomes After Laparoscopic Appendectomy for Appendicitis in Children

The purpose of this study was to determine if the postgraduate level of resident in the operating room correlates with outcomes for pediatric patients undergoing laparoscopic appendectomy. The charts of all children who underwent laparoscopic appendectomy for appendicitis from 2007 to 2011 at a free-standing children's hospital were reviewed. Outcomes of interest were compared between patient groups based on postgraduate level of the junior-most surgeon in the operating room: (1) junior resident (postgraduate year [PGY]-1, -2, and -3); (2) senior resident (PGY-4 or -5); (3) fellow (PGY-6 or -7); or (4) attending surgeon only. Junior resident (n=327), senior resident (n=129), fellow (n=246), and attending (n=73) groups were similar in terms of age (P=.69), gender distribution (P=.51), race (P=.08), and perforation status (P=.30). Operative time was shorter for senior residents (P=.002), fellows (P<.001), and attending surgeons operating without a resident (P<.001) compared with cases with junior residents. The rate of conversion to an open operation was similar among groups (P=.46). Resident level was not predictive of complications, which occurred in 26 junior resident cases (8.0%; referent), 17 senior resident cases (13.2%; odds ratio [OR] 1.73; P=.11), 33 fellow cases (13.4%; OR 1.71; P=.06), and 8 attending cases (11.0%; OR 1.62; P=.27). Fellow involvement was associated with an increased rate of postoperative percutaneous abscess drainage or re-operation for abscess or bowel obstruction (9.8%; OR 2.31; P=.020). Involvement of junior residents in pediatric laparoscopic appendectomy is associated with increased operative time but no higher rate of complications.

Lemmel's syndrome as a rare cause of obstructive jaundice

Obstructive jaundice is a frequent symptom most frequently resulting from choledocolithiasis or pancreatico-biliary and periampullary tumors. If duodenal diverticula are frequently asymptomatic, they can occasionally present with obstructive jaundice in the absence of lithiasis or another obstructing lesion such as a tumor in a presentation called Lemmel's syndrome. We herein present a 70-year-old male with obstructive jaundice secondary to a periampullary duodenal diverticulum associated with hepatic abscess. Endoscopic sphincterotomy associated with percutaneous abscess drainage released patient from all symptoms. Lemmel's syndrome as a rare cause of obstructive jaundice should be known in order to avoid mismanagement and therapeutic delay.

Percutaneous needle aspiration of breast abscesses

Background:Breast abscesses could be successfully treated by percutaneous aspiration of pus and irrigation of the cavity with saline solution.Objective:To assess the feasibility and effectiveness of percutaneous needle aspiration of breast abscesses under local anesthesia in the outpatient clinic.Patient and methods:A prospective study of forty three women with breast abscesses attended outpatient clinic at Tikrit teaching hospital and privit clinic for the period from January 2008 to January 2010.All patients had preliminary breast ultrasoundexamination. Percutaneous needle aspiration of pus under local anesthesia was done ,followed by systemic antibiotics. Repeated aspiration was carried out later when deemed necessary and follow up byultrasound was conducted.Results:Twenty three (53.4%) of patients obtained complete resolution (no focal collection) after one aspiration , 9 (21%) required two aspiration and 8 (18.6% )required more than two aspiration for cure (residual collection). In 3 ( 7% ) of patients, the treatment failed where symptoms not resolved after 3 days, with further pus collection despite aspiration and antibiotics , where surgical drainage were required.Conclusions:Percutaneous needle drainage of breast abscesses after preliminary breast US is feasible as a primary and definitive treatment for breast abscesses if complete or near complete drainage is achieved.

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).

Hepatic abscesses

Hepatic abscesses are potentially lethal diseases if early diagnosis and treatment are not instituted. They are prevalent all over the globe and pyogenic abscesses are predominant over amoebic. With better control of intra abdominal and systemic infections by a spectrum of antibiotics, aetiology of pyogenic abscesses are secondary to interventions and diseases in the biliary tree to a large extent today. The common organisms isolated are the Gram negative group. Amoebic abscesses continue to plague some regions of the world where hygiene and sanitation are questionable.Over the years, diagnosis, treatment and prognosis have evolved remarkably. Imaging modalities like ultrasonography and CT scan have become the cornerstone of diagnosis. The absence of ionizing radiation makes MRI an attractive alternative in patients who require multiple follow up scans. Serological testing in amoebic abscesses has become more reliable. Though antibiotics have remained the principal modality of management, percutaneous drainage of abscesses have vastly improved the chances of cure and bring down the morbidity drastically in pyogenic abscesses. Amoebic abscesses respond well to medical treatment with nitroimidazoles, and minimally invasive surgical drainage is an option in cases where open surgery is indicated.

Postoperative Komplikationen nach Darmresektionen bei Patienten mit Morbus Crohn: Risiko, Behandlung, Prävention

The postoperative morbidity rate following bowel resections for Crohn's disease is higher than for other benign disease. The incidence of postoperative intraabdominal septic complications (anastomotic leak, bowel fistula, intraabdominal abscess, peritonitis) is 5 - 30 %. Preoperative weight loss, prolonged refractory symptoms and penetrating disease behaviour are significant determinants of postoperative complication risk. Preoperative enteral nutrition, antibiotics, percutaneous abscess drainage and cessation of steroids might reduce the risk of surgery, however, more evidence is needed. The intake of immunosuppressive agents (mainly, azathioprine) can be continued perioperatively. The occurrence of postoperative intraabdominal septic complications is associated with an increased risk of surgical recurrence in patients with terminal ileitis, however, the long-term prognosis could be improved in the latter patients by secondary fecal diversion. There is no association between postoperative morbidity and long-term outcome in patients with Crohn's colitis.

USE OF A PARTIALLY COVERED SELF‐EXPANDABLE METALLIC STENT TO TREAT A BILIARY STRICTURE SECONDARY TO CHRONIC PANCREATITIS COMPLICATED BY RECURRENT CHOLANGITIS: A CASE REPORT

The patient was a 69 year old man who had been diagnosed with alcoholic chronic pancreatitis and lower common bile duct (CBD) stricture. He subsequently developed cholangitis 2-3 times a year, and we replaced the endoscopic biliary stent (EBS) each time. In April 2010, he was admitted because of complication by a liver abscess and acute cholangitis. We performed percutaneous transhepatic liver abscess drainage. The inflammatory findings then rapidly improved, but the patient developed acute cholangitis due to the sludge and the stones. Then, we placed a partially covered self-expandable metallic stent (C-SEMS) in the lower CBD and performed endoscopic lithotripsy through the C-SEMS, and the cholangitis subsequently improved. Two weeks after, we removed the C-SEMS endoscopically and replaced it with a 10 Fr plastic stent; since then there have been no recurrences of cholangitis. Our experience in this case suggested that when a plastic stent is placed long-term to treat a biliary stricture associated with chronic pancreatitis, it might be useful to also control biliary sludge and stones using a C-SEMS.

Diagnosis and subsequent US-guided percutaneous drainage of an adrenal abscess in a 5-week-old infant

Adrenal abscess is an uncommon finding in neonates and young infants. It may have a fatal outcome if inadequately treated. This case report describes the successful diagnosis and treatment of a left-sided adrenal abscess in a 5-week-old girl. Abdominal US and antigranulocyte antibody-scintigraphy showed an encapsulated suprarenal mass with debris suspicious for an adrenal abscess. Treatment is generally surgical. In this case, however, we performed US-guided percutaneous drainage combined with intravenous antibiotic treatment. The child recovered fully.

Mo1692 Short-Term Outcomes of Percutaneous Versus Surgical Treatment of Abdominal Abscesses in Crohn's Disease - a Nationwide Study

Introduction: Abdominal abscesses are a common complication in Crohn's disease (CD). Percutaneous drainage of such abscesses has become increasingly popular and may deliver outcomes comparable to surgical treatment; however, such comparative data are limited from single center studies. There have been no nationally representative studies comparing different treatment modalities for abdominal abscesses. Methods: We identified all adult CD related hospitalizations from the Nationwide Inpatient Sample 2007, the largest allpayer hospitalization database in the United States comprising over 1000 hospitals from 40 states. Intra-abdominal abscesses were identified from all non-elective admissions. Using administrative codes, treatment modality was categorized into 3 strata medical treatment alone, percutaneous drainage (perc), and surgical treatment (surg). We examined the impact of treatment modality on length of stay, hospitalization charges, and need for total parenteral nutrition (TPN) and stoma creation. Results: There were an estimated 3,296 hospitalizations for abdominal abscesses in patients with CD (mean age 41 years, 44%women). Approximately 39% were treated by medical treatment alone, 29% with percutaneous drainage, and 32% with surgery (Figure 1). The factors predictive of interventional treatment (perc or surg) were malnutrition (OR 2.4, 95%CI 1.3-4.5), and admission to a teaching hospital (OR 2.1, 95%CI 1.4-3.0). Mean time to percutaneous drainage and surgical treatment were 4.6 and 3.3 days respectively. Early percutaneous drainage (< 2 days) was associated with shorter hospitalizations (-8 days, 95%CI -11 to -5 days) and lower need for TPN (OR 0.45, 95%CI 0.20 1.04) (Figure 2). 27% of patients treated with surgery required creation of a temporary or permanent stoma. Compared to percutaneous drainage, surgical treatment was associated with longer hospitalizations (3.3 days, 95%CI 1.1-5.4 days), and greater hospitalizations costs ($34,314) Conclusion: We describe, for the first time, a nationwide pattern in the treatment of abdominal abscesses. Percutaneous drainage is associated with shorter length of hospital stay and lower hospitalization costs than surgical treatment. Early treatment (either percutaneous or surgical) is predictive of shorter hospitalization.