Diane Levis, Presenter: Nothing to Disclose

Debra Ann Gervais MD, Abstract Co-Author: Speakers Bureau, Tyco Healthcare (Valleylab), Boulder,CO

Raul Nirmal Uppot MD, Abstract Co-Author: Nothing to Disclose

Raul Nirmal Uppot MD, Abstract Co-Author: Nothing to Disclose

Ronald Steven Arellano MD, Abstract Co-Author: Nothing to Disclose

Peter Raff Mueller MD, Abstract Co-Author: Consultant, Cook Group Incorporated, Bloomington, IN

To evaluate the efficacy of tPA in improving drainage of abdominal collections refractory to simple catheter drainage.

46 patients underwent percutaneous image-guided drainage with 10 – 14 French catheters. Underlying etiologies were infected hematomas (16), anastomotic leak with abscess (7), postoperative abscesses (7), diverticulitis (5), appendicitis (3), biloma (2), post ERCP duodenal perforation (2), psoas abscess (2), liver abscess (1), perinephric abscess (1), tumor abscess (1), loculated peritonitis (1), and infected CSFoma from a VP shunt (1). Intracavitary tPA was initiated based on initial marked septation with extremely viscous contents yielding little to no drainage at initial placement or if follow up CT (24 – 72 hours after drainage) showed a large residual collection. A cycle of tPA was defined as 4 to 6 mg tPA diluted in an appropriate volume of 0.9% saline intracavitary twice a day for 3 days. Drainage success was defined as evacuation of the abscess without the need for surgery.

The 46 patients underwent 49 cycles of tPA in 49 abscesses. Complete evacuation was achieved in 43 abscesses (88 %) whereas 6 abscesses were only partially evacuated by the percutaneous catheter and required surgical debridement. Etiologies underlying incomplete drainage requiring surgery were pancreatic duct leak (2), tumor abscess (1), postoperative abscess (2), and multiloculated peritonitis (1). There were 3 recurrences (6%): a presacral abscess due to anastomotic leak, a periduodenal abscess from ERCP injury, and an infected hematoma. There were no complications with tPA. Specifically, there were no cases of bleeding into the abscess cavity in spite of 5 patients simultaneously receiving full therapeutic range systemic anticoagulation and 42 receiving prophylactic dose anticoagulation.

Intracavitary tPA is safe and effective in draining complex fluid collections, improving drainage in collections not initially drained at imaging, with most patients avoiding surgery.

Adjunctive intracavitary tPA enables complex collections refractory to simple catheter drainage to be completely evacuated with patients avoiding surgery for abscess drainage.

Levis, D, Gervais, D, Uppot, R, Uppot, R, Arellano, R, Mueller, P, Adjunctive Intracavitary tPA: Efficacy in Draining Complex Abdominal Collections.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4439130.html