Percutaneous Drainage of Abdominal Collections under

Imaging Guide

Nasser  M.  Meazher*

FICMS Mohammed A. Mahdi **  FICMS

Safa M. Al Obaidi***   FRCS, FACS     

Abstract:

Background: One of the most significant advances in the treatment of intra-abdominal collections during the past 2 decades has been the introduction of image-guided therapy with percutaneous catheter drainage. The development of improved imaging modalities, together with broad-spectrum antibiotics and soft drainage catheters, has changed the treatment of collections that previously required an urgent operation. Disease processes that have traditionally been treated with open surgical drainage and debridement can now be resolved with percutaneous catheter drainage and antibiotics. In selected cases, this will allow for better preparation of the patient for a later elective and definitive operation. Objective: Highlight the outcome, safety and effectiveness of percutaneous drainage procedure of abdominal collections performed under imaging guide. Patients and Methods: Forty one patients were referred from surgical wards and  emergency department after diagnosing abdominal collections. Then  each case discussed with radiologist to determine  the  route  and  type  of  catheter   and imaging  modality  for  guidance    (ultrasound and/or computerized tomography). The size and site of the collections were estimated along with the most suitable approach  and  angle  of catheter insertion. A safe drainage route was identified avoiding solid organs and bowel. Results: Percutaneous drainage of 41 abdominal collections under imaging control was carried out in 41 patients during a one year period. No complications resulted from the procedure itself. Percutaneous drainage was sufficient to drain the collections in 35 cases (no further surgery is needed). Of those who require surgery (5 patients), the procedure considered to be as a temporary measure. One case was diagnosed as sero-mucinous tumor of bowel. Conclusion: Percutaneous drainage of abdominal collections is a safe, effective and minimally invasive alternative approach to formal surgical drainage.The advantages include: the drainage can be done under local anesthesia, diagnosis and treatment can be achieved simultaneously in radiological department. Key words; Percutaneous drainage, Imaging guide, Collection.

Introduction:

Percutaneous catheter drainage (PCD) is now standard therapy for patients with intraabdominal collections who do not have other indications for surgery. The vast majority of collections can be managed with an appropriately sized and positioned catheters[1]. Percutaneous drainage is defined as the placement of a catheter using imaging guidance to provide continuous drainage of a fluid collection. [2]. Percutaneous aspiration is defined as evacuation of a fluid collections using either a catheter or needle, with removal of the catheter or needle immediately after the aspiration  [ 3, 4]. Contraindications of percutaneous drainage:  Common contraindications include uncorrectable coagulopathy and the absence of a safe percutaneous path access the collection [4,5,6]. Catheter insertion technique: There are two methods for introducing a catheter into collections: Trocar technique:The trocar technique involves a catheter

mounted on a sharp trocar and inserted into the abscess or collection  with a guiding needle [5,7] . Seldinger technique: The Seldinger technique involves the insertion of a hollow needle into the abscess cavity or the collection and the placement of a guide wire through the needle to create a percutaneous path for a drainage catheter [5,7] ..

Aim of the study: Evaluate the outcome of percutaneous drainage procedure of intraabdominal abscesses and fluid collections performed under imaging-guide and the effectiveness as alternative to open surgical drainage.