Percutaneous aspiration and drainage of abdominal fluid collections after pancreatic transplantation

Letourneau, J G; Hunter, Donald; Crass,; Thompson, W.R.E.; De, Sutherland

doi:10.2214/ajr.150.4.805

Cited by 13 publications

(7 citation statements)

References 4 publications

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“…3). 5 In this setting, perhaps because immunosuppression has been discontinued in many patients, success rates better approximate those in non-transplant drainage series.…”

Section: Pancreatic Allograftsmentioning

confidence: 99%

“…Similarly, imaging guidance for percutaneous aspiration and drainage procedures in these settings is typically accomplished with US or CT. [1][2][3][4][5][6][7] In many instances, US guidance alone is adequate, although in some patients, particularly hepatic or intraperitoneal pancreatic recipients, at least a preliminary diagnostic CT examination with gastrointestinal opacification is useful to exclude the presence of multiple collections and to localize bowel loops that may make catheter course planning difficult. Additionally, when the location of a target collection in relation to adjacent bowel loops or vascular structures is uncertain, CT with intestinal opacification, and occasionally with intravenous enhancement, is necessary.…”

Section: Imaging and Procedural Techniquesmentioning

confidence: 99%

“…Methods detailed in the literature for percutaneous aspiration and drainage in this set of patients do not vary substantially from those in non-transplant patients. [1][2][3][4][5][6][7] Diagnostic aspirations are generally performed with 18-to 21-gauge needles; percutaneous aspirations are almost uniformly successful in the acquisition of diagnostic material in transplant patients. Therapeutic drainages are usually done with 6F to 14F curved, pigtail, or Cope-type abscess, biliary, or urinary catheters, typically using a Seldinger or, less commonly, a trocar technique.…”

Section: Imaging and Procedural Techniquesmentioning

confidence: 99%

“…In patients with intraperitoneal grafts, catheter drainage usually is not successful. 5 However, in a small subset of patients (25%-33%), surgery can be totally avoided; 5 consequently, a therapeutic trial is probably indicated in most patients unless there is uncontrollable hemodynamic instability, suspected graft thrombosis mandating allograft pancreatectomy, or a sizeable duodenal or anastomotic leak related to the urinary bladder requiring surgical 309 repair. (Small urinary or anastomotic leaks can sometimes be managed by prolonged bladder decompression.…”

Section: Pancreatic Allograftsmentioning

confidence: 99%

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Percutaneous Aspiration and Drainage of Fluid Collections Complicating Solid Organ Transplants

Letourneau¹,

Ferral²,

Finlay³

et al. 1992

Semin intervent Radiol

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A number of different types of fluid collections complicate renal, hepatic, and pancreatic transplantation. These collections can be the source of considerable morbidity and even death for the transplant recipient and, depending on the location of the collection, can also be responsible for graft dysfunction. This paper reviews the impact of percutaneous aspiration and drainage on the management of transplant-related fluid collections. Little in the literature addresses this topic specifically; consequently, the material presented here most often reflects data culled from larger general reports on the complications of organ transplantation. IMAGING AND PROCEDURAL TECHNIQUESDetection of peritransplant or other abdominal fluid collections after transplantation is usually accomplished with sonography (US) or computed tomography (CT). A particular advantage of US over CT in the setting of perivascular collections is its Doppler capability, which permits a noninvasive determination of intramass flow and, therefore, the inclusion or exclusion of the diagnosis of pseudoaneurysm.Although much has been written on the characterization of fluid collections, such as lymphoceles, hematomas, abscesses, urinomas, bilomas, and pseudocysts, by US or CT features alone, definitive diagnosis of such collections requires the acquisition of fluid for laboratory and microbial analysis. Often, this fluid is obtained by percutaneous needle aspiration. Much of the ambiguous nature of papers addressing post-transplantation complications relates to the fact that fluid collections are not definitively characterized before the analysis of the clinical data. On the other hand, fluid collections may be rather specifically characterized by fluoroscopy when leakage is defined by a catheter study with contrast injection. In this manner, urinomas, bilomas, and leaks from pancreatic ducts or duodenocystosomies can be diagnosed directly, although obviously, the presence of superimposed infection cannot be determined.Similarly, imaging guidance for percutaneous aspiration and drainage procedures in these settings is typically accomplished with US or CT. 1-7 In many instances, US guidance alone is adequate, although in some patients, particularly hepatic or intraperitoneal pancreatic recipients, at least a preliminary diagnostic CT examination with gastrointestinal opacification is useful to exclude the presence of multiple collections and to localize bowel loops that may make catheter course planning difficult. Additionally, when the location of a target collection in relation to adjacent bowel loops or vascular structures is uncertain, CT with intestinal opacification, and occasionally with intravenous enhancement, is necessary. Fluoroscopic guidance for percutaneous procedures can be used when adequate contrast opacification of a collection is seen after a diagnostic catheter study; when fluoroscopic guidance is utilized, use of a rotational C-arm aids in determining the three-dimensional anatomic relations of the fluid collection to nearby structur...

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“…3). 5 In this setting, perhaps because immunosuppression has been discontinued in many patients, success rates better approximate those in non-transplant drainage series.…”

Section: Pancreatic Allograftsmentioning

confidence: 99%

Section: Imaging and Procedural Techniquesmentioning

confidence: 99%

Section: Imaging and Procedural Techniquesmentioning

confidence: 99%

Section: Pancreatic Allograftsmentioning

confidence: 99%

See 2 more Smart Citations

Percutaneous Aspiration and Drainage of Fluid Collections Complicating Solid Organ Transplants

Letourneau¹,

Ferral²,

Finlay³

et al. 1992

Semin intervent Radiol

View full text Add to dashboard Cite

show abstract

“…Computed tomography (CT) with retrograde bladder opacification is also helpful, and it is preferable in patients in whom other intraabdominal pathology (i.e., abscess) is suspected. Any fluid collections seen on CT scan may be aspirated percutaneously and sent for Gram's stain, culture, and determination of creatinine and amylase content [68].…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Pancreas-Kidney Transplantation for Intensivists: Perioperative Care and Complications

Fabrega

Rivas

Pollak

1994

J Intensive Care Med

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Simultaneous pancreas-kidney transplantation is a therapeutic option for type I diabetics with end-stage renal disease. It aims to correct the uremic state, to normalize glucose hemeostasis, and to ameliorate diabetic complications. Careful donor-recipient selection and meticulous intra-operative and postoperative care will substantially impact recipient morbidity. An understanding of the technical aspects of the surgical procedure and its metabolic and immunological consequences is necessary to successfully manage a pancreas-kidney transplant recipient, many of whom are nursed in intensive care units. A successful outcome is predicted in early recognition of technical complications and aggressive management of rejection to achieve the current 1-year graft survival rates of 75% for pancreas transplants and 84% for kidney transplants.

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Histopathological Syndromes of Pancreas and Islet Allograft Rejection and Recurrent Disease

Drachenberg

2014

Textbook of Organ Transplantation

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Percutaneous aspiration and drainage of abdominal fluid collections after pancreatic transplantation

Cited by 13 publications

References 4 publications

Percutaneous Aspiration and Drainage of Fluid Collections Complicating Solid Organ Transplants

Percutaneous Aspiration and Drainage of Fluid Collections Complicating Solid Organ Transplants

Pancreas-Kidney Transplantation for Intensivists: Perioperative Care and Complications

Histopathological Syndromes of Pancreas and Islet Allograft Rejection and Recurrent Disease

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