Abstract:
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Purpose: In the management of postoperative abscess, it is not always easy to drain abscess percutaneously through conventional image guided puncture because the anatomy has been frequently disturbed by the surgery. The aim of our study was to evaluate efficacy of fluoroscopy guided exchange of malfunctioning surgical drain in patients with postoperative abdominal abscesses.
Methods and Materials: During past 5 years, a total of 93 postoperative abdominal abscesses in 87 consecutive patients (55 men and 22 women; mean age, 59 years) was managed by a method of fluoroscopy guided exchange of occluded and/or malpositioned surgical drain to radiologic catheter. Indication of this procedure was (a) documented fluid collection that was potentially communicated with preexisting surgical drain, (b) suspected occlusion of surgical drain, and (c) fever and/or leukocytosis. Results of the procedures were reviewed. Mean follow-up period was 9 months (3-45months).
Results: Target postoperative abscesses were located in the space of right subphrenic (n = 35), left subphrenic (n = 18), peripancreatic (n = 16), right subhepatic (n = 12), pelvic (n = 6), left subhepatic (n = 4), and peritoneum (n = 2). Successful exchange of preexisting surgical drain with adequate positioning of a new drainage catheter in the target abscess was achieved in 84/93 (technical success rate: 90%) cases. In 9 cases with technical failure, percutaneous abscess drainage(PAD)through ultrasound guided puncture was performed. Of 84 procedures with technical success, complete resolution of abscesses was achieved in 74 (88%) patients without repeat PAD or surgery. Thus, overall cure rate of the procedure was 80% (74/93). Mean time interval between procedures and surgery was 13 days (1-55days). Catheter size ranged from 10 to 20 Fr, with 63 (75%) catheters being 14 F or larger. No procedural complication was seen.
Conclusion: Fluoroscopy guided exchange of malfunctioning surgical drain is an effective and safe procedure in the treatment of postoperative abscesses those are potentially communicated with preexisting surgical drain. With this method, deep seated lesion or lesion surrounded with bowel or other vital structure can be easily drained without invasive image guided puncture.
Kim MD, Y,
Fluoroscopy-guided Exchange of Malfunctioning Surgical Drain in Patients with Postoperative Abdominal Abscesses: 5-Year Experience. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3106636.html
