Computed tomography-guided percutaneous abscess drainage in coloproctology: review of the literature

Abstract

PAD is a safe and effective alternative to surgery for draining deep infected fluid collections, with a higher success rate, lower complication rate and shorter hospital stay compared to surgical drainage. Meticulous technique and careful access planning seem to be the two most important factors affecting the outcome.

Management of abdominal and pelvic abscess in Crohn’s disease

“…Delaying surgery also allows time for optimizing nutritional status and reducing or stopping corticosteroids [17,18] . If the abscess is drainable by PAD, the next step is to aspirate the collection in order to demonstrate the nature of the fluid [19] . As much pus as possible should be aspirated [20] .…”

“…Transabdominal and perineal approaches are also commonly used [19] . A drainage catheter should be left in place and the quality and quantity of its output should be measured daily.…”

“…The catheter should be flushed with 10-20 mL of saline every 6 h to assure patency [8] . Clinical improvement is usually seen within 48 h of successful drainage [8,19] . If fever persists, a repeat CT is indicated to assure that the catheter is properly positioned.…”

“…Antibiotics are generally not indicated for more than 7 d or until fever resolves [9] . If an abscess is not accessible by CT, endoscopic ultrasound (EUS) can be employed to drain the cavity by the transrectal or transvaginal approach [19,25,26] . For EUS, the abscess must be within 2 cm of the rectum or left colon [26] .…”

“…Generally, success is defined as resolution of symptoms with collapse of the abscess cavity and avoidance of early surgery (within 30-60 d) [3,5,10,20,28,29] . With this definition in mind, success rates vary from 50%-95% [3,5,8,19,23] . Multiple or multi-locular abscesses and those associated with a fistula are more often prone to failure [3,8,29] .…”