CT-guided special approaches of drainage for intraabdominal and pelvic abscesses

Abstract

BackgroundTo explore the safety and efficacy of several special approaches of drainage for deep inaccessible intraabdominal and pelvic abscesses.MethodsBy searching of our institutional database, the clinical and radiologic information of all patients with special approaches of abscesses drainage was collected, consisting of etiology, diameter of abscess, duration of drainage, major complications, rates of success, failure and death, and pre-procedure, intra-procedure and post-procedure computed tomography scans.ResultsA total of 124 patients are eligible for the criterion in our center between January 2010 and January 2018. The mean diameter of abscess was 5.6 cm (range 3.0–9.8 cm) and mean duration of drainage was 10.3 days (range 4–43 days). Pain was complained in 6 patients (4.8%) and hemorrhage was observed in one patient. Complete resolution of the abscess following drainage was observed in 115 patients (92.7%). A total of 9 patients (7.3%) failed to percutaneous abscess drainage and 3 patients died of catheter-unrelated diseases. Transintestinal afferent loop of drainage was firstly attempted in six patients and complete resolution of abscess was achieved in five patients.ConclusionSpecial approaches, including transgluteal, presacral space, transhepatic, multiplane reconstruction (MPR)-assisted oblique approach and transintestinal afferent loop approach for those deep inaccessible intraabdominal and pelvic abscesses are safe and feasible.

Biliary injuries after pancreatic surgery: interventional radiology management

“…Intraabdominal abscesses can be superinfected through contamination by colonized bile and therefore must be treated in order to prevent other comorbidities such as abdominal haemorrhage, prolonged hospitalization, and higher mortality (40,41). The common signs and symptoms are abdominal pain (83%), fever (80.5%), chills and perspiration (56%).…”

“…Imaging-guided techniques of percutaneous abscess drainage (PAD) lead to minimal tissue trauma and low morbidity and mortality rates (40). PAD are considered the first line treatment in both the paediatric and adult patients, in the absence of indications for immediate surgery (2,(41)(42)(43). Ultrasound, CT, and fluoroscopy are the imaging modalities most frequently used for PAD.…”

“…PAD may be performed using the Seldinger technique or the trocar technique, after subcutaneous administration of anaesthesia and IV moderate sedation. The Seldinger technique is a multistep procedure in which dilation and drain placement are performed after proper needle placement (2,41,42,44,45). The trocar technique is a monophasic procedure that is performed with a coaxial needle and drainage system.…”

“…According to the Society of Interventional Radiology guidelines, major complications may include: catheterrelated pain, haemorrhage, infection and sepsis, fistula formation or visceral injury along the access route such as bowel obstruction or perforation (2,41). Indeed, minor complications are referring to catheter dislodgement and obstruction (41). The complication rate shown in literature is 2.5% (41).…”

“…Indeed, minor complications are referring to catheter dislodgement and obstruction (41). The complication rate shown in literature is 2.5% (41). When PAD fails for the presence of septations or highly viscous contents, thrombolytic agents may be used to facilitate complete evacuation of abscess contents such as intracavitary urokinase in adults, tissue type plasminogen activator in paediatric patients (42)(43)(44).…”