Percutaneous Abscess Drainage Research Articles

Management of acute necrotizing pancreatitis with duodenal fistula

Severe acute pancreatitis (SAP) is often accompanied by severe infected pancreatic necrosis. Gastrointestinal fistula is a common complication during the infectious period of SAP, with the incidence of duodenal fistula coming in second place after colon fistula and a high mortality rate. Percutaneous catheter drainage (PCD) is the most commonly used surgical technique for necrotizing infection in SAP. However, the traditional PCD method cannot achieve adequate source control in SAP necrotizing infection patients with gastrointestinal fistulas. This report describes a case of SAP necrotizing infection complicated with a duodenal fistula treated with trocar-assisted percutaneous abscess drainage combined with manual irrigation. After treatment with double-lumen catheter irrigation and drainage combined with manual irrigation and other standards of care for SAP, the patient’s infection symptoms were gradually relieved. A review of abdominal computed tomography and gastrointestinal radiography showed that the intra-abdominal infection was gradually relieved, and the duodenal fistula was completely healed.

Hounsfield Units as an Independent Predictor of Failed Percutaneous Drainage of Spinal Tuberculosis Paraspinal Abscess Under Computed Tomography Guidance.

To investigate the value of Hounsfield units (HUs) as an independent predictor of failed percutaneous drainage of spinal tuberculosis paraspinal abscess under computed tomography (CT) guidance. A retrospective analysis was conducted on 61 patients who underwent CT-guided percutaneous drainage for spinal tuberculosis paraspinal abscess between October 2017 and October 2020. Preoperative CT scans were used to measure the HUs of the abscess. Patients were categorized into successful drainage (n = 49) and failed drainage (n = 12) groups. Statistical analysis involved independent sample t-tests and chi-square tests to compare between the 2 groups. Binary logistic regression was performed to identify independent predictive factors for drainage failure. Receiver operating characteristic (ROC) curves were employed to ascertain risk factor thresholds and diagnostic performance. Among the patients, 49 experienced successful drainage while 12 faced drainage failure. The mean HUs of abscesses in the failed drainage group were significantly higher than those in the successful drainage group (p < 0.001). ROC analysis revealed an area under the curve of 0.897 (95% confidence interval, 0.808-0.986) for predicting drainage failure based on HUs. The optimal HU cutoff value for predicting drainage failure was 22.3, with a sensitivity of 91.7% and specificity of 69.4%. HUs are an independent predictor of failed percutaneous drainage of spinal tuberculosis paraspinal abscess under CT guidance. The HU value of 22.3 can be used as an initial screening threshold for predicting the success or failure of drainage.

RESULTS OF THE ANTIBIOTICS TREATMENT COMBINED WITH LIVER ABSCESS DRAINAGE AT NGUYEN TRI PHUONG HOSPITAL

Background: Percutaneous drainage of liver abscess is the initial treatment of choice for abscesses larger than 5 cm in size and has long been applied in many hospitals in Vietnam. However, there are not many summary reports on both antibiotic treatment and abscess drainage under ultrasound guidance. Subjects and methods: Retrospective study of patients with liver abscess who were treated with antibiotics and drained the abscess under ultrasound guidance at Nguyen Tri Phuong Hospital from January 2017 to March. 12/2022. Results: There were 61 patients included in the study. The first-line antibiotic treatment is Cephalosporin III generation combined with intravenous metronidazole, most are sensitive to third generation Cephalosporins (49.2%), 8.2% are multi-resistant ESBL-secreting bacteria using Carbapenems. The treatment success rate is high (96.7%). The time for the patient to have no fever and no pain in the right lower quadrant is from 1 to 4 days. Most of the interventions were 1 time (90.2%). The average tube retention time was 12 days. Conclusion: Treatment of liver abscess with antibiotics combined with ultrasound-guided drainage is an effective and safe measure. Most of the cases are only intervention 1 time with high success rate.

ОСОБЕННОСТИ ДИАГНОСТИКИ И ХИРУРГИЧЕСКОЙ ТАКТИКИ В ЛЕЧЕНИИ ПАЦИЕНТОВ ПРИ НЕОПУХОЛЕВЫХ ОБРАЗОВАНИЯХ ПЕЧЕНИ

Abstract. Introduction. Etiology of benign non-neoplastic liver lesions is quite diverse. They are usually represented by both purulent inflammatory and parasitic foci. Non-tumor lesions are characterized by severe course and by difficulties in diagnosing and managing the patients. Aim. The aim of the study was to analyze the characteristics of the diagnostic search and surgical treatment of patients with non-neoplastic liver lesions, based on the experience of our clinic.Materials and Methods. Treatment cases of 34 patients with non-tumor liver foci were analyzed by our team. We studied the steps of diagnosing non-neoplastic liver lesions and the surgical approaches to treatment, based on the etiology and nature of each liver lesion. Results and Discussion. In 79% (n=27) of all cases, focal diseases have been observed over the last three years. Etiologically, liver segment lesions were different. In 53.6% (n=18) of cases, 2-3 segments were affected simultaneously. In 11.7% (n=4) of cases, bilobar liver damages were detected. In liver abscesses, minimally invasive surgical approaches were used predominantly; in 70.9% (n=24) of cases, percutaneous abscess drainage was performed under ultrasound navigation. In 8.8% (n=3) of cases, abscess was redrained with a catheter; in 5.8% (n=2) of cases, abscess cavity was evacuated by puncturing. In cholangiogenic abscesses, the leading purpose was to resolve the hypertension of the bile ducts, followed by the abscess drainage. Smaller cholangiogenic abscesses were managed conservatively. Mortality was 5.8%. (n=2) in all groups of interest. Conclusion. In diagnosing the non-neoplastic liver lesions, an integrated approach is required, considering the present history and laboratory findings. In this case, the diagnosis standard is the use of ultrasound technology and computed tomography scans, while magnetic resonance imaging is indicated for diagnosing pathological factors relating to bile ducts. Surgical approaches are dependent on the nature of the pathological process. Minimally invasive technique under ultrasound navigation is the key technique for treating patients with purulent inflammatory liver lesions.

Assessment of the Outcome of USG Guided Percutaneous Drainage of Liver Abscess with and Without Administration of Intra Cavitary Meropenem &amp; Urokinase

Assessment of the Outcome of USG Guided Percutaneous Drainage of Liver Abscess with and Without Administration of Intra Cavitary Meropenem &amp; Urokinase

HPB P48 Liver Abscess Secondary to Cocktail Stick Migration Following Accidental Ingestion

Abstract Background Liver abscess formation following foreign body ingestion is rare. This may occur if the foreign body is lodged in the upper gastrointestinal tract and persists. Initial management consists of antibiotics with or without percutaneous abscess drainage. However, referral to the regional HPB unit may need to be considered to discuss foreign body retrieval, especially if it is located within the liver parenchyma itself, in order to treat persistent sepsis or prevent abscess recurrence in the future. Methods A 38-year-old gentleman, previously healthy, presented to the emergency department of a district general hospital with nausea, upper abdominal pain, and fever. He stated that he had accidentally ingested a piece of a wooden cocktail stick while eating some weeks back. Leucocytosis and raised inflammatory markers were present on bloodwork. Computed tomography revealed a 6 cm hypoattenuating lesion in the left lobe of the liver, which demonstrated features of a hepatic abscess on magnetic resonance imaging. Abdominal ultrasound visualised a 4 cm linear hyperechoic structure within the hypoechoic lesion, raising the suspicion of foreign body retention with abscess formation. Results The fever subsided, and symptoms resolved with antibiotics. Follow-up imaging revealed abscess resolution with foreign body persistence in the liver. He was referred to the regional HPB unit and underwent laparoscopy for foreign body removal. A fistulous communication between liver segment II and lesser curvature of the stomach was seen and disconnected using diathermy. Minimal pus was drained and the foreign body retrieved. The gastric perforation was sealed using a linear stapling device. A nasogastric tube was left in the stomach until the patient tolerated a liquid diet and discharged on the first post-operative day. He remains well on follow-up. Conclusions This case highlights that scrupulous history taking and imaging review are required for a timely diagnosis of foreign body retention.

Complicated Appendicitis-An Update : A Narrative Review

Complicated Appendicitis is defined as perforated appendicitis with abscess or mass formation. Its diagnosis and management have been controversial with no consensus on its definition and treatment algorithm. The treatment was initially conservative management, but the current trend is immediate appendectomy by the laparoscopic method. Other areas of controversy include the need for interval appendectomy and the role of percutaneous drainage of appendicular abscess. We have conducted this review article to investigate the definition, diagnosis, and treatment of complicated appendicitis.

EUS-guided versus percutaneous liver abscess drainage: A multicenter collaborative study.

Management of hepatic abscesses has traditionally been performed by image-guided percutaneous techniques. More recently, EUS drainage has been shown to be efficacious and safe. The aim of this study is to compare EUS-guided versus percutaneous catheter drainage (PCD) of hepatic abscesses. Patients who underwent EUS-guided drainage or PCD of hepatic abscesses from January 2018 through November 2021 from 4 international academic centers were included in a dedicated registry. Demographics, clinical data preprocedure and postprocedure, abscess characteristics, procedural data, adverse events, and postprocedure care were collected. Seventy-four patients were included (mean age, 63.9 years; 45% male): EUS-guided (n = 30), PCD (n = 44). Preprocedure Charlson Comorbidity Index scores were 4.3 for the EUS group and 4.3 for the PCD group. The median abscess size was 8.45 × 6 cm (length × width) in the EUS group versus 7.3 × 5.5 cm in the PCD group. All of the abscesses in the EUS group were left-sided, whereas the PCD group contained both left- and right-sided abscesses (29 and 15, respectively). Technical success was 100% in both groups. Ten-millimeter-diameter stents were used in most cases in the EUS group, and 10F catheters were used in the PCD group. The duration to resolution of symptoms from the initial procedure was 10.9 days less in the EUS group compared with the PCD group (P < 0.00001). Hospital length of stay was shorter in the EUS group by 5.2 days (P = 0.000126). The EUS group had significantly fewer number of repeat sessions: mean of 2 versus 7.7 (P < 0.00001) and trended toward fewer number of procedure-related readmissions: 10% versus 34%. The PCD group had a significantly higher number of adverse events (n = 27 [61%]) when compared with the EUS group (n = 5 [17%]; P = 0.0001). EUS-guided drainage is an efficacious and safe intervention for the management of hepatic abscesses. EUS-guided drainage allows for quicker resolution of symptoms, shorter length of hospital stay, fewer adverse events, and fewer procedural sessions needed when compared with the PCD technique. However, EUS-guided drainage may not be feasible in right-sided lesions.

Surgical rescue strategies and techniques for severe intra-abdominal infection

Severe intra-abdominal infection is complicated with sepsis or septic shock and could also be named as intra-abdominal sepsis. Surgical rescue is an effective intervention for severe intra-abdominal infection, which can be caused by surgery, trauma or acute abdomen. Institutional factors associated with failure of surgical rescue include hospital volume, technology, surgeons and nurses. Patient factors contributing to failure include advanced age, diabetes mellitus and chronic organ dysfunction. The surgical rescue strategy for severe intra-abdominal infection includes damage control surgery and damage control resuscitation. Stepwise escalated procedures based on the severity of the infections should be performed as soon as possible to control the infection source, including removal of catheter in blood vessel, change of intra-abdominal drainage, trochar-assisted percutaneous abscess drainage (TA-PAD), laparotomy and open abdomen therapy. Since most of the pathogenic microorganisms of severe abdominal infections are multi-drug resistant bacteria expressing Klebsiella pneumoniae carbapenemase (KPC), the choice of empirical antibiotics can be guided by rapid identification of the KPC type before the results of antibiotic susceptibility testing are available, namely the antibiotic selection strategy of "enzyme first, then bacteria".

Neglected Biliary Stent with Hepatico-lithiasis Causing Left Lobe Pyogenic Liver Abscess with Rupture into Left Pleural Cavity: A rare Life-threatening Emergency

Abstract Biliary tract disease is currently the leading cause of pyogenic liver abscess (PLA) and complications of rupture are associated with high mortality and morbidity even with current medical knowledge advancement. We report a 35-year-old female who presented in emergency setting with complaints of jaundice, abdominal pain, fever, and respiratory distress. Patient had prior history of endoscopic management of biliary stones about 6 years back followed by asymptomatic period. Patient was managed by percutaneous drainage of left lobe liver abscess and left pleural empyema after initial resuscitation with further investigations revealing biliary stent with left hepatic abscess with transdiaphragmatic extension into left hemithorax. Neglected biliary stent has been reported to cause severe cholangitis with PLAs and these patients require immediate timely attention to the management of abscess and its complications.

Epidemiology and Clinical Patterns of Lung Abscesses in ICU: A French Multicenter Retrospective Study

Data are scarce regarding epidemiology and management of critically ill patients with lung abscesses. What are the clinical and microbiological characteristics of critically ill patients with lung abscesses, how are they managed in the ICU, and what are the risk factors of in-ICU mortality? This was a retrospective observational multicenter study, based on International Classification of Diseases, 10th Revision, codes, between 2015 and 2022 in France. In-ICU mortality-associated factors were determined by multivariate logistic regression. We analyzed 171 ICU patients with pulmonary abscesses. Seventy-eight percent were male, with a mean age of 56.5 ± 16.4 years; 20.4%misused alcohol, 25.2%had a chronic lung disease (14%COPD), and 20.5%had a history of cancer. Overall, 40.9%were immunocompromised and 38%qualified for nosocomial infection. Presenting symptoms included fatigue or weight loss in 62%, fever (50.3%), and dyspnea (47.4%). Hemoptysis was reported in 21.7%. A polymicrobial infection was present in 35.6%. The most frequent pathogens were Enterobacteriaceae in 31%, Staphylococcus aureus in 22%, and Pseudomonas aeruginosa in 19.3%. Fungal infections were found in 10.5%. Several clusters of clinicoradiologic patterns were associated with specific microbiological documentation and could guide empiric antibiotic regimen. Percutaneous abscess drainage was performed in 11.7%; surgery was performed in 12.7%, and 12%required bronchial artery embolization for hemoptysis. In-ICU mortality was 21.5%, and age (OR: 1.05 [1.02-1.91], P= .007], renal replacement therapy during ICU stay (OR, 3.56 [1.24-10.57], P= .019), and fungal infection (OR, 9.12 [2.69-34.5], P= .0006) were independent predictors of mortality after multivariate logistic regression, and drainage or surgery were not. Pulmonary abscesses in the ICU are a rare but severe disease often resulting from a polymicrobial infection, with a high proportion of Enterobacteriaceae, S aureus, and P aeruginosa. Percutaneous drainage, surgery, or arterial embolization was required in more than one-third of cases. Further prospective studies focusing on first-line antimicrobial therapy and source control procedure are warranted to improve and standardize patient management.

Percutaenous Drainage of Deep Neck Space Abscess Under Ultrasonography Guidance

Deep neck space abscess, usually caused by dental or upper airway infection, is a troublesome disease in otorhinolaryngology. It can cause serious complications such as airway obstruction, mediastinitis and sepsis, and sometimes require emergency operation (incision and drainage). Recently, percutaneous drainage under ultrasonography guidance has been reported to show more therapeutic effects and advantages than surgery. However, in most cases, it is performed by radiologists and there are no reports explaining the procedures in detail. Therefore, we would like to introduce the methods and tips of ultrasonography-guided percutaneous drainage of deep neck space abscess directly performed by otorhinolaryngologists.

The three-tube method via precise interventional placement for esophagojejunal anastomotic fistula after gastrectomy: a single-center experience

BackgroundEsophagojejunal anastomotic leakage is a serious complication after total gastrectomy. This study evaluated the safety and efficacy of transnasal placement of drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy for treatment of esophagojejunal anastomotic fistula after gastrectomy in gastric cancer patients.MethodsThis is retrospective review of patients with esophagojejunal anastomotic fistula treated with transnasal placement of abscess drainage catheter, decompression tube, and jejunal nutrition tube under fluoroscopy. Fistula healing time, patient survival, and Eastern Cooperative Oncology Group (ECOG) performance status before and after treatment were evaluated.ResultsSixty-four patients were included in the study. Insertion of the transnasal abscess drainage catheter, decompression tube, and jejunal nutrition tube was successful on the first attempt in all patients, while 35 patients received transnasal abscess drainage, 13 received percutaneous abscess drainage, and 16 received transnasal drainage plus percutaneous abscess drainage. Immediately after placement of the tube, the mean volume of drainage was 180 mL (range, 10–850 mL); the amount steadily decreased from then on. The clinical success rate was 84.3% (54/64). Median time to fistula healing was 58 days (range, 7–357 days).ConclusionsTransnasal insertion of transnasal abscess drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy appears to be a simple, minimally invasive, effective, and safe method for treating esophagojejunal anastomotic fistula after gastrectomy.

Significance of Postprocedural Contrast Medium Injection after CT-Guided Abscess Drainage.

The aim was to evaluate the additive clinical value of an additional post-procedural control-scan after CT-guided percutaneous abscess drainage (PAD) placement with contrast medium (CM) via the newly placed drain. All CT-guided PADs during a 33-month period were retrospectively analyzed. We analyzed two subgroups, containing patients with and without surgery before intervention. Additionally, radiological records were reevaluated, concerning severe inflammatory response syndrome (SIRS) during the intervention. A total of 499 drainages were placed under CT-guidance in 352 patients. A total of 197 drainages were flushed with CM directly after the intervention, and 51 (26%) showed an additional significant finding. An immediate change of therapy was found in 19 cases (9%). The subgroup that underwent surgery (120 CM-drainages; 32 (27%) additional findings; 13 (11%) immediate changes of therapy) showed no statistically significant difference compared to the subgroup without surgery (77 CM-drainages; 19 (25%) additional findings; 5 (6%) immediate changes of therapy). SIRS occurred in 2 of the 197 flushed drainages (1%) after CM application. An additional scan with CM injection via the newly placed drain revealed clinically significant additional information in almost 26% of the drainages reviewed in this study. In 9% of the cases this information led to an immediate change of therapy. Risks for SIRS are low.

Surgical rescue strategies and techniques for gastrointestinal fistulas

Abstract A gastrointestinal fistula is a severe medical condition that may lead to sepsis or septic shock. It requires immediate response and valid treatment to prevent subsequent deterioration. Surgical rescues are effective measures to cope with aforementioned situations, but there remain challenges in successful implementation. Institutional factors, including constrained hospital volume, technological gap, and limited competence of surgeons and nurses, could lead to surgical failure to rescue (FTR), while high-risk patient characteristics such as aging, diabetes mellitus, and chronic organ dysfunction have a bearing on the outcome as well. Surgical rescue strategies encompass damage control surgery and resuscitation. Based on disease severity, sequential damage control measures involving vessel catheter removal, abdominal drainage tube replacement, trocar-assisted percutaneous abscess drainage, laparoscopic drainage, and open abdomen therapy should be applied accordingly.

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.

Percutaneous drainage of liver abscess under ultrasound guidance combined with etiological antibacterial therapy: a successful case of patient treatment

The article describes a clinical case of successful treatment of multiple liver abscesses in a 43‑year-old man with severe comorbidity and history of aggravating factors. The patient underwent combined treatment: surgery, consisting in the abscess puncture, and antibacterial therapy, first empirical, then etiological, taking into account the data of bacteria culture test. The importance of rational combinations of surgical care and antibacterial therapy is also discussed.

Enterolith Causing Afferent Loop Perforation After Distal Gastrectomy

Afferent loop syndrome is a complication that occurs after the Billroth Ⅱ reconstruction or Roux-en-Y reconstruction and can also be caused by enteroliths. We experienced a case of duodenal perforation due to afferent loop syndrome caused by an enterolith, in which surgical removal of the enterolith and decompression of the duodenum were effective. A 73-year-old female who underwent distal gastrectomy and Roux-en-Y reconstruction for gastric cancer 14 years ago came to the hospital with acute abdominal pain and underwent emergency surgery for afferent loop syndrome and duodenal perforation due to enterolith. The patient underwent removal of the enterolith, drain placement, and placement of a decompression tube in the duodenum. Postoperatively, percutaneous drainage of the intra-abdominal abscess was necessary, but the patient was saved without reoperation. Afferent loop perforation may occur with obstruction due to enteroliths, and the surgical insertion of a tube to decompress the afferent loop is effective.

Endobronchial Watanabe Spigot Placement for Hepatic Abscess and Bronchobiliary Fistula Following Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report.

A bronchobiliary fistula (BBF) is an uncommon but severe complication after radiofrequency ablation (RFA). However, the definitive salvage methods are controversial. We herein report a patient with hepatocellular carcinoma with hepatic abscess and BBF following RFA. We also review previous reports of BBF after RFA. The patient was a man in his 70s who underwent RFA for recurrent hepatocellular carcinoma in the subphrenic area. Despite percutaneous transhepatic abscess drainage, bilioptysis persisted. Finally, the BBF was occluded with an endobronchial Watanabe spigot under fiber-optic bronchoscopy. Placing an endobronchial Watanabe spigot should be considered as a salvage therapy for refractory BBF following RFA.

Potts puffy Tumor

Pott puffy tumor is a rare entity, characterized by the association of a subperiosteal abscess and osteomyelitis of the frontal bone. It is often secondary to frontal sinusitis or trauma. We report the case of a 14-year-old child who presented with a Pott’s tumor following frontal sinusitis, complicated by subdural empyema. He was successfully treated with antibiotic therapy and percutaneous drainage of the frontal abscess.