Abstract
Objective
The purpose of this study is to describe our experience with the role of CT-guided percutaneous drainage of loculated intra-abdominal collections consisting entirely of gas.
Materials and methods
An IRB-approved retrospective study analyzing patients with air-only intra-abdominal collections over an 8-year period was undertaken. Seven patients referred for percutaneous drainage were included. Size of collections, subsequent development of fluid, and microbiological yield were determined. Clinical outcome was also analyzed.
Results
Out of 2835 patients referred for percutaneous drainage between 2004 and 2012, seven patients (5M, 2F; average age 63, range 54–85) met criteria for inclusion with CT showing air-only collections. Percutaneous drain placement (five 8 Fr, one 10 Fr, and one 12 Fr) using Seldinger technique was performed. Four patients (57%) had recently undergone surgery (2 Whipple, 1 colectomy, 1 hepatic resection) while two (29%) had a remote surgery (1 abdominoperineal resection, 1 sigmoidectomy). Despite the lack of detectable fluid on the original CT, 6 patients (86%) had air and fluid aspirated at drainage, 5 (83%) of the aspirates developed positive microbacterial cultures. Four patients (57%) presented with fever at the time of the initial scan, all of whom had positive cultures from aspirated fluid. Four patients (57%) had leukocytosis, all of whom had positive cultures from aspirated fluid.
Conclusions
Although relatively rare in occurrence, patients with air-only intra-abdominal collections with signs of infection should be considered for percutaneous management similar to that of conventional infected fluid collections. Although fluid is not visible on CT, these collections can produce fluid that contains organisms.
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References
Gervais DA, Hahn PF, O’Neill MJ, Mueller PR (2002) Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years. Radiology 222(3):645–651. doi:10.1148/radiol.2223010554
Marin D, Ho LM, Barnhart H, et al. (2010) Percutaneous abscess drainage in patients with perforated acute appendicitis: effectiveness, safety, and prediction of outcome. Am J Roentgenol 194(2):422–429. doi:10.2214/AJR.09.3098
Park J, Charles HW (2012) Intra-abdominal abscess drainage: interval to surgery. Semin Intervent Radiol 29(4):311–313. doi:10.1055/s-0032-1330065
Tyrrel RT, Murphy FB, Bernardino ME (1990) Tubo-ovarian abscesses: CT-guided percutaneous drainage. Radiology 175(1):87–89. doi:10.1148/radiology.175.1.2315507
Feagins LA, Holubar SD, Kane SV, Spechler SJ (2011) Current strategies in the management of intra-abdominal abscesses in Crohn’s disease. Clin Gastroenterol Hepatol 9(10):842–850. doi:10.1016/j.cgh.2011.04.023
Cinat ME, Wilson SE, Din AM (2002) Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg 137(7):845–849
Mueller PR, Saini S, Wittenburg J, et al. (1987) Sigmoid diverticular abscesses: percutaneous drainage as an adjunct to surgical resection in 24 cases. Radiology 164(2):321–325. doi:10.1148/radiology.164.2.3602369
Burkhart RA, Relles D, Pineda DM, et al. (2013) Defining treatment and outcomes of hepaticojejunostomy failure following pancreaticoduodenectomy. J Gastrointest Surg 17(3):451–460. doi:10.1007/s11605-012-2118-9
Gervais DA, Ho CH, O’Neill MJ, et al. (2004) Recurrent abdominal and pelvic abscesses: incidence, results of repeated percutaneous drainage, and underlying causes in 956 drainages. Am J Roentgenol 182(2):463–466. doi:10.2214/ajr.182.2.1820463
Kassi F, Dohan A, Soyer P, et al. (2013) Predictive factors for failure of percutaneous drainage of postoperative abscess after abdominal surgery. Am J Surg. doi:10.1016/j.amjsurg.2013.07.041
Ciftci TT, Akinci D, Akhan O (2012) Percutaneous transhepatic drainage of inaccessible postoperative abdominal abscesses. Am J Roentgenol 198(2):477–481. doi:10.2214/AJR.11.6680
Harisinghani MG, Gervais DA, Maher MM, et al. (2003) Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology 228(3):701–705. doi:10.1148/radiol.2283020924
Siewert B, Tye G, Kruskal J, et al. (2006) Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. Am J Roentgenol 186(3):680–686. doi:10.2214/AJR.04.1708
Wallace MJ, Chin KW, Fletcher TB, et al. (2010) Quality improvement guidelines for percutaneous drainage/aspiration of abscess and fluid collections. J Vasc Interv Radiol 21(4):431–435. doi:10.1016/j.jvir.2009.12.398
Arellano RS, Gervais DA, Mueller PR (2011) CT-guided drainage of abdominal abscesses: hydrodissection to create access routes for percutaneous drainage. Am J Roentgenol 196(1):189–191. doi:10.2214/AJR.10.4731
Varghese JC, O’Neill MJ, Gervais DA, Boland GW, Mueller PR (2001) Transvaginal catheter drainage of tuboovarian abscess using the trocar method: technique and literature review. Am J Roentgenol 177(1):139–144. doi:10.2214/ajr.177.1.1770139
Jaques P, Mauro M, Safrit H, Yankaskas B, Piggott B (1986) CT features of intraabdominal abscesses: prediction of successful percutaneous drainage. Am J Roentgenol 146(5):1041–1045. doi:10.2214/ajr.146.5.1041
Weinstein S, Osei-Bonsu S, Aslam R, Yee J (2013) Multidetector CT of the postoperative colon: review of normal appearances and common complications. Radiographics 33(2):515–532. doi:10.1148/rg.332125723
Boccola MA, Lin J, Rozen WM, Ho YH (2010) Reducing anastomotic leakage in oncologic colorectal surgery: an evidence-based review. Anticancer Res 30(2):601–607
Power N, Atri M, Ryan S, Haddad R, Smith A (2007) CT assessment of anastomotic bowel leak. Clin Radiol 62(1):37–42. doi:10.1016/j.crad.2006.08.004
Hirst N, Tiernan J, Millner P, Jayne D (2013) Systematic review of methods to predict and detect anastomotic leakage in colorectal surgery. Colorectal Dis. doi:10.1111/codi.12411
Lucey BC, Maher MM, Boland GW, Gervais DA, Mueller PR (2002) Percutaneous treatment by interventional radiologists of anastomotic leaks: basic concepts. Am J Roentgenol 179(2):365–369. doi:10.2214/ajr.179.2.1790365
Allen BC, Barnhart H, Bashir M, et al. (2012) Diagnostic accuracy of intra-abdominal fluid collection characterization in the era of multidetector computed tomography. Am Surg 78(2):185–189
Jaffe TA, Nelson RC, Delong DM, Paulson EK (2004) Practice patterns in percutaneous image-guided intraabdominal abscess drainage: survey of academic and private practice centers. Radiology 233(3):750–756. doi:10.1148/radiol.2333032063
DuBrow RA, David CL, Curley SA (1995) Anastomotic leaks after low anterior resection for rectal carcinoma: evaluation with CT and barium enema. Am J Roentgenol 165(3):567–571. doi:10.2214/ajr.165.3.7645472
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Patel, B.N., Morgan, M., Tyler, D. et al. The role of CT-guided percutaneous drainage of loculated air collections: an institutional experience. Abdom Imaging 40, 3257–3264 (2015). https://doi.org/10.1007/s00261-015-0537-2
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DOI: https://doi.org/10.1007/s00261-015-0537-2