Pigtail Catheter Drainage Research Articles

Clinical spectrum and management outcome in gallbladder perforation-a sinister entity: Retrospective study from Sub-Himalayan region of India.

Gallbladder perforation is an infrequent entity seen among surgical patients. Rare occurrence owes to difficulty in diagnosing gallbladder perforations. The aim of the present study was to determine the optimal management strategy that may decrease the morbidity and mortality associated with this potentially life-threatening condition. This was a retrospective study from hospital health records wherein the experience of 40 consecutive patients with gallbladder rupture, either spontaneous or secondary to both benign conditions and malignancy, was noted at a tertiary care hospital over 48 months from February 2017 till January 2021. The etiology, clinical presentation, and treatment given were analysed. Out of 40 patients included, 23 were females and the majority of patients were more than 45 years of age. Twelve patients responded to intravenous antibiotics and analgesics alone while five required an ultrasound-guided pigtail catheter drainage due to non-improving clinical condition. The failure of expectant management led to a delayed laparotomy in seven patients while four patients required emergency laparotomy because of generalized peritonitis. An elective cholecystectomy was offered to 12 patients with cholecystoenteric fistulae after diagnostic laparoscopy in the same admission. Thirty-eight patients were discharged in stable condition and doing well at 30-day follow-up. Gallbladder perforation is seen more commonly in acute calculous cholecystitis compared to other conditions. It is more evident when the treatment of acute calculous cholecystitis is delayed by more than 6-8 weeks. The spectrum of clinical presentation varies from mild pain and vomiting to generalized peritonitis. The patient often requires a step-up approach to control the ongoing sepsis for an improved outcome.

ROLE OF OPEN SURGICAL DRAINAGE OR ASPIRATION IN MANAGEMENT OF AMOEBIC LIVER ABSCESS

Background: Since Hippocrates time, liver abscesses have been recognised. Apart from postoperative care, advancements in diagnostic and therapeutic methods have greatly lowered the high mortality rate. The present study aimed to establish the role of open surgical drainage or aspiration in management of amoebic liver abscess. Methodology: The present prospective observational study involved 30 patients aged over 18 years of both sexes who were hospitalised to the department of general surgery with symptoms consistent with liver abscess and were confirmed with amoebic liver abscess. Following enrollment, a complete clinico-medical and admission history, as well as a thorough physical examination, were obtained. Routine serological testing in addition to abdominal and pelvic ultrasonography are performed. Additional CECT abdominal procedures were conducted. Results: Out of 30 enrolled patients, 70.00% were male, and 30.00% were female. Out of the 30 cases in this study, 5 patients who had percutaneous aspiration had many minor abscesses, and one patient with a solitary abscess required open surgery due to recurring liver abscess. Under antibiotic coverage, the majority of patients required USG-guided percutaneous aspiration or pigtail catheter drainage. Conclusion: Surgical drainage or aspiration are both equally effective in treating patients with amoebic liver abscesses.

Study of Liver Abscess Drainage by Needle Aspiration v/s Pigtail Catheter Drainage in a Tertiary Care Hospital

Study of Liver Abscess Drainage by Needle Aspiration v/s Pigtail Catheter Drainage in a Tertiary Care Hospital

Analysis and Comparative Study of Catheter Drainage or Needle Aspiration in Management of Liver Abscess

Background: Liver abscess is common cause of illness in developing nations. Even with the advance investigation like ultrasonography, the diagnosis is still delayed due to the nonconclusive manifestations of disease and for that reason the tentative diagnosis is important. Methods: 60 patients were selected from L.G. HOSPITAL, Ahmedabad. Study was conducted during the period from June 2020 to October 2021. Results: Percutaneous catheter drainage is having less compliance compared to needle aspiration. Repeated procedures needed to improve the success of percutaneous needle aspiration 56.66% of the subjects presented with complications in USG guided needle aspiration group whereas only 26.66% of people presented with complications in USG guided pigtail catheter drainage group. The most common complication in needle aspiration group was re-accumulation leading to repeated aspiration 40%. The of the most common complication in catheter drainage group is blockage of drain due to thick pus 10%. Conclusions: USG guided catheter drainage and USG guided needle aspiration are equally efficient in the management of significant sized liver abscesses.

Role of Pigtail Catheter Drainage Versus Percutaneous Needle Aspiration in the Management of Liver Abscess: A Retrospective Analysis.

IntroductionA liver abscess is an important health concern in tropical countries. Effective management of liver abscesses includes appropriate antibiotics and drainage of the abscess cavity. Percutaneous abscess drainage by pigtail catheterization is now gaining popularity. We analyzed the role of pigtail catheter drainage over percutaneous aspiration in the treatment of liver abscesses.Methods and materialThis was a retrospective analytical study conducted in a tertiary care center in western India. Patients of age ≥ 18 years admitted with the diagnosis of liver abscess were included in this study. To find the effectiveness of different treatment modalities, data were analyzed in three groups: Group A (Conservative treatment), Group B (Percutaneous needle aspiration), and Group C (Pigtail catheter drainage).ResultsA total of 64 patients with a liver abscess were analyzed. There was male predominance (93.75%). Mean abscess volume in Group C (307.9 ± 212.8 ml) was significantly higher when compared to Group A (130.8 ± 72.9 ml, p = 0.03) and Group B (177.2 ± 129.5; p = 0.024). The duration of hospital stay and residual abscess volume at the time of discharge did not show a statistically significant difference between treatment groups. Pigtail catheterization of abscesses with volume >150 ml shortened the hospital stay, whereas it prolonged the hospital stay in patients with abscess volume <150 ml.ConclusionPercutaneous pigtail catheterization would be an operative decision for the management of liver abscess. We concluded that the use of pigtail catheterization of patients with abscess volume > 150 ml improved the clinical outcome.

Management of iatrogenic right ventricular puncture: A case report

A 100-year-old female patient was admitted for a pericardial effusion with unknown etiology. Pericardiocentesis was performed and the pigtail drainage catheter was noted to be in the right ventricle and not pericardial space. A separate pigtail catheter was placed in the pericardial space and the existing pigtail catheter was removed under close hemodynamic monitoring. The patient subsequently stabilized. This case demonstrates that puncture of the right ventricle may be treated conservatively.

A prospective study of outcome of double pigtail catheter drainage in the management of breast abscess: analysis of outcome

Background: Breast abscesses, localized collection of pus in the breast, are most common in young lactating women. Traditional treatment of breast abscesses is by surgical incision, digital disruption of septa, evacuation of contents with occasional placement of surgical drains, and administration of systemic antibiotics. Percutaneous large-bore needle aspiration with or without ultrasound guidance is generally employed as the first line treatment of breast abscesses. It is generally done for medium to large sized unilateral abscesses and requires repeated aspirations for complete resolution of the abscess cavity.Methods: We have conducted this prospective study at SMIMER Hospital, Surat, Gujarat, India from January 2020 to January 2021. After ethical approval a group of 25 patients with unilateral breast abscesses irrespective of the lactational status were treated by percutaneous double catheter drains inserted under ultrasound guidance under the effect of local anaesthesia and evaluated for 3 months.Results: The resultant cosmetic effect was good, with no reported recurrence on 3 month follow-up.Conclusions: Double pigtail catheter drainage in appropriately selected cases of beast abscess has superior outcome in compare to published result of other technique for drainage of beast abscess specially in minimal scarring, early resolution of abscess cavity and decreases in the total duration of treatment.

Outcome and Complications of Percutaneous Transhepatic Biliary Drainage: Influence of Liver Entry Site

Objective: To determine the outcome and complications of percutaneous transhepatic biliary drainage (PTBD) performed via right lobe and left lobe duct puncture. Study Design: Cross-sectional study. Place and Duration of Study: Department of Interventional Radiology, Dow Institute of Radiology, Dow University of Health Sciences from July 2020 to March 2021. Methodology: Both adult male and female patients with obstructive jaundice having dilated intrahepatic biliary ducts on ultrasound were included. PTBD was performed under ultrasound guidance. Following intrahepatic biliary duct puncture, a guide wire was inserted followed by placement of 8 Fr or 10 Fr pigtail drainage catheter. Total bilirubin level was measured before and one day after the procedure. Cholangiogram was performed 48 hours after the procedure to check the drain placement and residual dilatation. Results: 130 patients were included with mean age of 55.3 ± 12.3 years. Success rate was same in patients with right and left lobe puncture i.e. 96.9%. The frequency of complication in right lobe puncture was higher (37.5%). Mean procedure time was significantly higher in patients who developed complications (75.92 ± 19.20 minutes) as well as mean exposure time was also significantly higher in patients who developed complications (12.00 ± 6.87 minutes) as compared to patients who did not develop any complication (8.08 ± 3.43 minutes) (p &lt;0.05). Conclusion: It was concluded that the success rate in right and left lobe puncture was equal and complication rate in right lobe puncture was observed to be high as compared to left lobe puncture. Keywords: Biliary drainage, Complications, Effect, Liver

COMPARATIVE STUDY OF OUTCOMES OF PERCUTANEOUS NEEDLE ASPIRATION VERSUS PIGTAIL CATHETER DRAINAGE FOR SOLITARY LIVER ABSCESS.

Objective: The aim of this study was to compare the outcomes of ultrasound guided percutaneous needle aspiration and percutaneous pigtail catheter drainage in the treatment of solitary liver abscess with respect to successful drainage, clinical improvement, reduction in size of abscess cavity, duration of hospital stay and procedure related complications. Methods: Prospective randomized study on 108 patients treated over a period of 30 months. Using standard randomization they were divided equally into two groups A and B. Group A patients underwent usg guided percutaneous needle aspiration for a maximum of three attempts, and Group B patients were treated by pigtail catheter drainage. All the patients received a uniform protocol based supportive care and antimicrobial treatment. Outcomes were compared with respect to successful drainage, resolution of symptom, fty percent reduction in size of abscess cavity, hospital stay duration and procedure related complications. Results: A successful drainage was noted in 52(96%) patients in group B treated with PCD and 46 (84%) patients in group A treated with PNA. 8(11%) patients in group A did not respond to three attempts due to very thick pus and they were offered pigtail catheter drainage. The duration required for initial clinical improvement and fty percent reduction of size of abscess cavity was signicantly lesser in group B. Though the duration of hospital stay was lesser in group B the difference was not statistically signicant. Complication was noted only in group B where one patient developed perihepatic and subdiaphragmatic collection and the other had peritonitis. Both were cured after surgical intervention. Conclusion: Both percutaneous needle aspiration and pigtail catheter drainage are almost equally effective in the treatment of solitary liver abscess. Though pigtail catheter drainage helped in earlier clinical improvement and reduction in cavity size but the difference in duration required for full recovery and complete resolution of abscess cavity was not statistically signicant. Hence the selection of the procedure needs to be individualized and should take into account various factors like patient's general condition, laboratory parameters, and nature of abscess cavity.

Misdiagnosed case of liver sub-capsular hematoma in a child managed with percutaneous pigtail catheter drainage

Hepatic hematoma sometimes has a non-specific presentation with non-specific history especially in pediatric age group. Clinical signs and symptoms may vary &amp; sometimes misleading results in delays in diagnosis and higher morbidity. We present a case of a 9-year old male child with a liver subcapsular hematoma with Perihepatic collection, initially misdiagnosed as liver abscess.

Image Guided percutaneous pigtail catheter drainage of Liver Abscess technique and its outcome

Background: Liver abscesses are localized collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents. These abscesses are usually suspected clinically in cases having fever and tender hepatomegaly. The diagnosis is usually confirmed on the basis of imaging such as ultrasound and computerised tomography. Management includes antimicrobial agents and drainage of abscess. Percutaneous drainage of abscess is done using needle aspiration or catheter drainage.&#x0D; Aims and Objective: The main aim of the study was to evaluate the role of pigtail catheterization drainage procedure as a treatment option in cases of liver abscess.&#x0D; Materials and Methods: It was a prospective study conducted ata tertiary care medical college. Fifty patients having hepatic abscess were included in this study over a period of one year from August 2018 to September 2019 on the basis of a predefined inclusion and exclusion criteria. These patients underwent pigtail catheterization of liver abscess as a treatment. The demographic characteristics, hepatic lobe involvement, offending organisms and complications were studies in these patients.&#x0D; Results: Out of 50 patients 35 were male and 15 were femalewith a M: F ratio of 1:0.42. The age ranged from 4 years to 92 years. The mean age of the studied cases was found to be 38.64 +/- 18.17 years. Right lobe was involved in predominant cases. most common individual organism involved in hepatic abscess formation was klebsiella (30%) followed by streptococcus (20%) and E-coli (8%) organisms. Seven patients developed procedure related complications out of which 5 patients had catheter dislodgment requiring repositioning of catheter 1 patient developed pus discharge from catheter site and remaining 1 patient developed subcapsular hematoma.&#x0D; Conclusion: Percutaneous image guided pigtail catheter of liver abscess is an effective minimal procedure as a treatment option for liver abscess with high success rate with no mortality related to procedure.

A Case Report: Trans-Thoracic Pigtail Catheter with Diaphragm Perforation

Pigtail catheters are commonly used as effective alternative to traditional large bore chest tubes. However, the pigtail catheter placement does not come without possible complications. Pneumothorax, hemothorax and rarely visceral or vascular injury were all reported previously. Here we report a case of an 80-year-old patient who presented with right-sided rib fractures and right hemothorax post mechanical fall. A pigtail drainage catheter (PC) was placed; however, minimal drainage was obtained and there was no resolution of hemothorax. CT evaluation showed the PC located between the liver and the underside of right hemidiaphragm.

Double Pigtail to Manage Pericardial Rupture of Left Lobe Liver Abscess

Background: Liver abscess if left untreated can rupture into adjoining pleura, pericardium, peritoneum. Rupture into pericardium, though very rare, is a dreaded complication and worsens the prognosis. Presentation here can be nonspecific. Rupture into pericardium if associated with cardiac tamponade often requires pericardiotomy. Case information: A 16-year boy presented with epigastric pain, fever and recent onset chest discomfort. No signs of cardiac tamponade were seen on clinical examination. Investigations revealed a left lobe liver abscess rupturing into pericardium and asymptomatic pericardial effusion. Serological testing confirmed the etiology to be amebic. The condition was using pigtail catheter drainage in both the pericardial cavity and hepatic abscess. Discussion: Ruptured liver abscess occurs more commonly due to delay in diagnosis. It increases the severity of disease depending upon the site of rupture. Pericardial rupture is the most feared complication out of these. Published literature lacks reports of asymptomatic pericardial rupture of liver abscess, and management options. Available literature reports invariable requirement of surgical drainage for this entity. This report shows that lesser invasive drainage procedures can successfully resolve this dreaded complication. Conclusion: Amoebic liver abscess rupturing into pericardium can be asymptomatic. Successful management with percutaneous drainage and double pigtail catheters offers resolution and avoids morbidity associated with surgical drainage.

A clinical study of liver abscess in patients attending the surgical department. A single center experience.

Liver abscess is a condition that is seen by surgeons all over the world. The patients present to the surgical department with features of right hypocondrial pain, fever and jaundice. Investigations such as ultrasound of the abdomen and CT scan of the abdomen are extremely useful in diagnosing a case of liver abscess. The two main causes of liver abscess are amoebic and pyogenic liver abscess. Occasionally a liver abscess may also occur due to fungal infection. Treatment modalities include the use of drugs such as metronidazole for amoebic liver abscess, as well as needle aspiration and pigtail catheter drainage when required. This was a prospective study was carried out from August 2015 to July 2018, for a period of three years. The study was conducted at SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India. Investigations such as complete blood count (CBC), chest x-ray, x-ray abdomen, ultrasound of the abdomen and CECT of the abdomen were done. A total of 57 patients were studied and the results obtained were analysed.

Ultra-sonography guided pigtail placement for drainage of liver abscess in 40 patients: A retrospective study

Aim and Objective: 1. To evaluate the advantages of USG guided pigtail catheter placement for drainage of liver abscess. 2. To assess the morbidity and complications of percutaneous pigtail catheter drainage in treatment of liver abscess. Methods: The study was conducted at Zydus Medical College and Hospital, Dahod, Gujarat, January 2018 to January 2020. It included 40 USG confirm cases of liver abscess. The liver Abscess ≥5x5 cm underwent percutaneous drainage was determined by doing serial USG scans.Results: Age group varied from 20 to 60 years. Out of 40 patients 36 were men and 4 were women. The male to female ratio 10:1. 28 patients had solitary abscess, while 12 had multiple abscess. Pigtail catheter of various sizes (10 F or 12 F) were introduced in these patients using the Seldinger technique. The volume of pus drained ranged from 150 to 400 ml, complications were minor and included catheter blockage in 8 patients and tract pain in 35 patients. There was no mortality associated with this procedure. This study shows a success rate of 96%. One patient required repeat pigtail placement after 6 months for recurrent liver abscesses. Conclusion: This study concludes that drainage of liquefied moderate to large sized liver abscess by USG guided pigtail placement as a minimally invasive procedure with low morbidity and mortality and should be first line of management of liver abscesses.

Outcomes in Delayed Drainage of Hemothorax.

Prompt drainage of traumatic hemothorax is recommended to prevent empyema and trapped lung. Some patients do not present the day of their trauma, leading to their delayed treatment. Delayed drainage could be challenging as clotted blood may not evacuate through a standard chest tube. We hypothesized that such delays would increase the need for surgery or secondary interventions. Our trauma registry was reviewed for patients with a hemothorax admitted to our level 1 trauma center from 1/1/00 to 4/30/19. Patients were included in the delayed group if they received a drainage procedure >24hours after injury. These patients were matched 1:1 by chest abbreviated injury score to patients who received drainage <24hours from injury. A total of 19 patients with 22 hemothoraces received delayed drainage. All but 3 patients had a chest tube placed as initial treatment. Four patients received surgery, including 3 who initially had chest tubes placed. Longer time to drainage increased the odds of requiring intrathoracic thrombolytics or surgery. In comparison, 2 patients who received prompt drainage received thrombolytics (P = .11) and none required surgery (P = .02). Patients needed surgery when initial drainage was on or after post-injury day 5, but pigtail catheter drainage was effective 26days after injury. Longer times from injury to intervention are associated with increased likelihood of needing surgery for hemothorax evacuation, but outcomes were not uniform. A larger, multicenter study will be necessary to provide better characterization of treatment outcomes for these patients.

USG GUIDED PERCUTANEOUS NEEDLE APIRATION VERSUS USG GUIDED PIGTAIL CATHETER DRAINAGE IN THE MANAGEMENT OF LIVER ABSCESS - A PROSPECTIVE RANDOMISED CONTROLLED STUDY

Background: The aim of this study was to determine and compare the therapeutic effectiveness and safety of USG guided percutaneous continuous catheter drainage and USG guided percutaneous needle aspiration in the treatment of liver abscess in Trichy. Methods: This is a prospective randomised comparative study of 50 patients, presented in outpatient and emergency department at the hospital, randomised equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of their treatment was measured in terms of duration of hospital stay, time taken for improvement of clinical symptoms, time taken for 50% reduction in cavity size and total or near total reduction of abscess cavity. Independent t-test was used to analyse these parameters. Results: The success rate was significantly better in catheter drainage group. Patients in pigtail catheter drainage group showed earlier clinical improvement (p 0.000) and 50% reduction in abscess cavity volume (p 0.000) and near total reduction of abscess cavity was earlier (p 0.019) as compared to those who underwent percutaneous needle aspiration. Conclusion: Our study concludes that percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration in respect to clinical improvement, reduction of cavity and success rate.

Amoebic Liver Abscess and treatment difficulties

Most common form of extra intestinal amoebiasis is amoebic liver abscess. Ultrasonogram (USG) is the investigation of choice for diagnosis and for performing therapeutic procedures of liver abscess. It is treated medically with or without surgical intervention. A 5 year old child came with fever and right hypochondrial (RHC) pain. He was found to have amoebic liver abscess which was diagnosed with USG and liver aspirate for microscopy. He needed Pigtail Catheter Drainage (PCD) and chloroquine as he failed to respond to metronidazole therapy and Percutaneous Needle Aspiration done twice (PNA).

3D-printed radiopaque polymer composites for the in situ monitoring of biodegradable medical implants

The development of biodegradable medical implants that are observable through rapid and non-invasive imaging techniques is crucial toward the treatments of many illnesses. However, the tracking of biodegradable medical devices in post-implantations remains problematic, due to the intrinsic radio-transparency of polymeric device. In this study, we developed a 3D-printable radiopaque polymer with tunable degradation rates and mechanical properties, and can be characterized through X-ray and computed tomography (CT). Three radiopacifiers were introduced to poly(glycerol sebacate) acrylate (PGSA), including barium sulfate, bismuth subcarbonate, bismuth oxychloride, and resulted in radiopacities that are equivalent in intensities to commercial BIOTEQⓇ pigtail drainage catheters. The changes in mechanical properties with varying concentration of radiopacifiers were studied, and bismuth oxychloride embedded PGSA (PGSA-BiOCl) was chosen for in vitro degradation over 30 days. The linear correlation between the mass loss and decrease in radiopacity of PGSA-BiOCl over time indicates the possible application of PGSA-BiOCl toward the monitoring of degrading implants, in contrast with similar PCL products. Through digital light processing additive manufacturing (DLP-AM), PGSA-BiOCl was proven to be 3D-printable and equally visible under radiological imaging when comparing to commercial products.

Comparison between the Efficacy of Conservative Management and Ultrasound Guided Pigtail Catheter Drainage of Uncomplicated Amoebic Liver Abscess

Comparison between the Efficacy of Conservative Management and Ultrasound Guided Pigtail Catheter Drainage of Uncomplicated Amoebic Liver Abscess