Abstract
Purpose
This study was undertaken to evaluate the efficacy of image-guided percutaneous drainage in treating abdominal and pelvic abscesses.
Materials and methods
From August 2001 to August 2006, 95 patients (49 men and 46 women; mean age 61 years, range 25–92) with 107 abscesses underwent image-guided percutaneous drainage. Thirty-one abscesses were retroperitoneal (9 peripancreatic, 17 perirenal, 5 pararenal), 37 intraperitoneal (2 in communication with the small bowel), 8 intrahepatic (2 in communication with the extrahepatic biliary system and 2 with the intrahepatic biliary system), 4 perisplenic and 27 pelvic (4 in communication with the large bowel). Seventy-one of 107 procedures were performed with ultrasonographic (US) guidance and 36/107 with computed tomography (CT) guidance. All procedures were carried out with 8-to 14-Fr pigtail drainage catheters.
Results
Immediate technical success was achieved in 107/107 fluid collections. No major complications occurred. In 98/107 abscesses, we obtained progressive shrinkage of the collection (>50%) with consequent clinical success. In 9/107 cases, percutaneous drainage was unable to resolve the fluid collection. There were 12 cases of catheter displacement and six of obstruction.
Conclusions
Percutaneous drainage is feasible and effective in treating abdominal and pelvic abscesses. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.
Riassunto
Obiettivo
Valutare la fattibilità del drenaggio percutaneo imaging-guidato nel trattamento degli ascessi addomino-pelvici.
Materiali e metodi
Dall’agosto 2001 all’agosto 2006, 95 pazienti (49 uomini e 46 donne, età media 61 anni, range 25–92) portatori di 107 raccolte sono stati sottoposti a drenaggio percutaneo imaging guidato. Trentuno raccolte erano retroperitoneali (9 peripancreatiche, 17 perirenali, 5 pararenali), 37 intraperitoneali (2 comunicanti con l’intestino tenue), 8 intra-epatiche (2 in comunicazione con il sistema biliare extraepatico e 2 con il sistema biliare intraepatico), 4 peri-spleniche e 27 pelviche (6 comunicanti con l’intestino crasso). Settantuno/107 procedure sono state realizzate sotto guida ecografica, 36/107 sotto guida TC utilizzando drenaggi percutanei di calibro variabile tra 8–14 Fr.
Risultati
Il successo tecnico immediato è stato ottenuto in 107/107 raccolte. Non si sono verificate complicanze maggiori. In 98/107 raccolte il drenaggio percutaneo ha realizzato una progressiva riduzione dimensionale (>50%) con successivo successo clinico. In 9/107 raccolte, il drenaggio percutaneo si è dimostrato inefficace. Si sono verificati 12/107 sposizionamenti e 6/107 ostruzioni del catetere.
Conclusioni
La procedura percutanea si è dimostrata tecnicamente fattibile ed efficace nel trattamento delle raccolte addominali e pelviche proponendosi in parte come tecnica propedeutica, in prevalenza come valida pancrealternativa alla chirurgia tradizionale che peraltro non viene preclusa in caso di insuccesso.
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Laganà, D., Carrafiello, G., Mangini, M. et al. Image-guided percutaneous treatment of abdominal-pelvic abscesses: a 5-year experience. Radiol med 113, 999–1007 (2008). https://doi.org/10.1007/s11547-008-0320-3
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DOI: https://doi.org/10.1007/s11547-008-0320-3