Case report: Percutaneous drainage of periappendiceal actinomycosis

Abdominal actinomycosis is a disorder which often complicates a chronic perforation of the gastrointestinal (GI) tract, such as at the appendix (Wyngaarden and Smith, 1988). Delayed diagnosis characterizes abdominal actinomycosis. Multiple abscesses and draining sinuses are frequently present. Treatment has consisted of long-term oral antibiotic therapy coupled with surgery, including incision and drainage of abscesses with removal of persistent sinuses (Berardi, 1979). We present a patient with abdominal actinomycosis complicating a chronically ruptured appendix who was managed by percutaneous catheter drainage and antibiotic therapy.     

Percutaneous drainage of abscesses: a report of 100 patients

One hundred patients had abscesses drained percutaneously in a variety of sites. Eighty-five per cent were treated successfully with a 6% mortality. There are now several large series in the literature, totalling over 250 patients with an average cure rate of over 80% and a mortality of under 5%. Percutaneous drainage of abscesses should become the treatment of choice in a vast majority of patients in whom the abscess can safely be reached.     

Percutaneous drainage of abdominal abscesses

Percutaneous puncture with echographic guide was performed in 37 patients with suspected abdominal abscesses. The abscess has been confirmed in 31 cases and it has been related to previous surgery in 21. In 3 cases the 3 small cavities were evacuated by a single-stage aspiration; in the other cases different drainage catheters, in relation to the size and the content of the cavities have been employed. Benefits of proteolytic agents, irrigation with saline solution and permanent aspiration are stressed. Successful drainage avoiding surgery was achieved in 23/31 patients (74%), and positive results have been obtained in multiple abscesses, multilocular abscesses and infected haematomas as well. A partial success was achieved in 3 cases (10%): the patients were submitted to surgery after a clinical improvement. Two complications occurred (bowel perforation and small liver laceration). The percutaneous drainage turned out to be a technique of choice in the great majority of abdominal abscesses, and should be considered a good alternative to surgery, particularly in high risk patients.     

Percutaneous drainage of subphrenic abscesses

Forty subphrenic abscesses were drained percutaneously in 37 patients. These abscesses were subsequent to abdominal surgery (28 patients), biliary obstruction and/or fistula (six patients), trauma (two patients) or acute pancreatitis (one patient). The procedures were usually monitored by duplex sonography and fluoroscopy (35 out of 40 cases), with an angled subcostal approach to the subphrenic space in over 85% of the cases. Forty-three drainage catheters were inserted using the Seldinger method; 37 (86%) had a size of 12 F or more, 21 were 16 F in size. Only two out of 43 catheters were double-lumen sump drains. The clinical condition improved after insertion of the catheter in all 37 patients. Definitive successful drainage, defined as hospital discharge without complementary surgery, was achieved in 32 patients (87%), without major complications. A temporizing effect was obtained in three additional patients (8%) who underwent curative surgery for the underlying process after complete drainage of the abscess. Two patients died from multiple organ failure before their abscess healed. Considerations for successful drainage of subphrenic abscesses include a good knowledge of the subphrenic space anatomy, the use of large-bore drainage catheters and the recognition and correct management of underlying enteric, biliary or pancreatic fistulas.     

Percutaneous drainage of abdominal abscesses

Abdominal abscesses carry high morbidity and mortality unless properly drained. In recent years, percutaneous drainage has become an accepted alternative to surgery. A brief overview of diagnostic principles, selection of patients, percutaneous drainage catheters and technique, contraindications, and post-drainage follow-up is presented. In experienced hands, more than 80% of abdominal abscesses can be drained successfully by this method and with lower rates of morbidity, mortality, and complications than by surgery.     

Percutaneous drainage of abscesses in patients with Crohn disease

Up to one-quarter of patients with Crohn disease present with abdominal abscesses at some point in their illnesses, most of which have enteric communication. The efficacy of percutaneous drainage alone vs either a combined percutaneous/surgical approach or a purely surgical approach has not been established. We reviewed the results of percutaneous drainage of nine abscesses in eight patients with Crohn disease. Six of these abscesses communicated with the intestine. Those with enteric communication had temporary palliation, with improved medical status. However, all patients required definitive surgery within 7 weeks of initial drainage. Percutaneous drainage in the three patients without enteric communication resulted in a permanent cure. Our experience with this small series suggests that abscesses that have an enteric communication in patients with Crohn disease can be temporarily palliated by percutaneous drainage. However, use of this technique is unlikely to result in long-term palliation or cure. It appears that abscesses with intestinal communication in Crohn patients can be cured by percutaneous therapy alone.     

Percutaneous catheter drainage of breast abscesses

Experiences with ultrasonically guided percutaneous catheter drainage of breast abscesses (BA) are presented. The 12 cases were: 10 non-lactating women, one lactating woman and one HIV-positive man. The percutaneous procedure employed was successful in all cases. The mean duration of drainage was 5 days post-catheter insertion. All percutaneous drainages and subsequent follow-up were performed in the outpatient clinic. No recurrence of BA was observed. Percutaneous drainage of BA is a simple, effective and economical technique. Its use is recommended as an alternative to surgical drainage.     

Percutaneous drainage of pyogenic liver abscesses

This report summarizes the results of percutaneous catheter drainage in 23 cases of primary or secondary pyogenic liver abscess. The overall success rate was 76%. Only three (60%) of five cases of secondary abscess (infected hematoma or infected tumor) were cured with catheter drainage, but 11 (91%) of the last 12 primary pyogenic abscesses were drained successfully. Six patients with abscesses of less than 4 cm in diameter required catheter drainage for less than 72 hr. Although six abscesses in the series appeared septated or multiloculated, only one required more than a single catheter for curative drainage. Diagnostic and technical considerations for successful drainage of hepatic abscesses are discussed. The differential diagnosis includes echinococcal disease and hepatic amebiasis. Therapeutically, specific measures should be taken to ensure proper catheter position to prevent contamination of the subphrenic, perihepatic, and pleural spaces. Percutaneous catheter drainage should be attempted as a first choice of treatment in all pyogenic hepatic abscesses.     

Percutaneous drainage of tubo-ovarian abscesses.

The authors performed percutaneous drainage of 27 tubo-ovarian abscesses (TOAs) in 16 patients in whom medical therapy with triple antibiotics prior to catheter drainage had not been successful. Percutaneous drainage was successful in 15 of 16 patients (94%). One patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy 3 days after catheter placement because of persistent symptoms and lack of drainage from the catheter; at laparotomy, a large infected phlegmon was found. Two patients had recurrent disease at 3 and 4 months after catheter placement. Bilateral salpingectomy was performed in one patient and total abdominal hysterectomy and bilateral salpingo-oophorectomy in the other. One of these patients had cervical carcinoma, and the other had a long history of recurrent pelvic inflammatory disease and TOAs. The long-term avoidance of surgery was 81.2%. Access routes for catheter drainage were through the anterior abdominal wall for 10 abscesses, through the posterior transgluteal route for 11, and through the transvaginal route for six. Duration of drainage was 1-20 days (mean, 6 days). Complications consisted of transient sciatic pain in two patients and mild bacteremia in one. The results indicate that percutaneous drainage of TOAs is effective in patients in whom medical therapy is not successful.     

Percutaneous drainage of renal and perirenal abscesses: results in 30 patients

The purpose of this study was to determine the efficacy of percutaneous drainage of renal and perirenal abscesses. Thirty-two abscesses, 10 renal and 22 renal with perirenal extension, in 30 patients (16 female, 14 male; age range, 5-83 years), were drained percutaneously. Twenty-one patients had had surgery recently and/or were immunosuppressed. Ten of the 13 postoperative patients had had surgical procedures involving the urinary tract. Size of the abscesses ranged from 10 to 650 ml, and all were drained via CT or fluoroscopic guidance. The type of drainage catheter used depended on the size of the abscess. Complications were unusual. A transient febrile episode without sequelae within the first 12 hr of catheter placement was the most common complication. All patients had their abscess catheter placed while in the hospital; 12 (40%) subsequently were followed up (2-50 days) as outpatients until their catheters were removed without complications. Percutaneous drainage alone was curative in 20 patients (67%) as determined by resolution of signs and symptoms or follow-up CT. Eight (27%) had improvement of signs and symptoms but required surgery to remove tumor (one patient) or a poorly functioning or nonfunctioning kidney (five patients), perform open pyelolithotomy (one patient), or drain a loculated abscess (one patient); all eventually were cured. Three patients (10%) with multiple medical problems died before resolution could be documented, although death was not thought to be directly related to failure of therapy. Our results indicate that percutaneous drainage alone is curative in the majority of cases of renal and perirenal abscesses. Many patients can be treated safely, in part, on an outpatient basis.     

Percutaneous drainage of chest abscesses in children

Seven patients ranging in age from 3 to 18 years underwent percutaneous drainage of eight intrathoracic abscesses. Five of the abscesses were mediastinal or paramediastinal and resulted from esophageal perforation or esophageal anastomotic leakage. The abscesses resolved in each case, with a mean catheter drainage time of 28 days and no need for surgical intervention. Three of the abscesses were intrapulmonary, and each lay adjacent to a pleural surface. All three lung abscesses resolved within 19-24 days, without thoracotomy or wedge resection.     

Percutaneous drainage of complicated abscesses and fluid collections

The original concept of percutaneous, radiological abscess drainage was confined to well circumscribed, solitary abscesses, that could be reached by a short access avoiding transgression of uninvolved organs or compartments. With increasing experience criteria for percutaneous abscess drainage have been expanded to radiological treatment of pancreatic, periappendiceal, diverticular, interloop and mediastinal abscesses and fluid collections. The authors present their experience with percutaneous treatment of such "complicated" abscesses in 140 patients.     

超声引导下肝脓肿介入治疗的临床研究

目的 :比较超声引导下针刺抽吸术与置管引流术在肝脓肿治疗中的优劣。方法 :将 30例肝脓肿患者随机分组 ,针刺抽吸组 15例 ,置管引流组 15例 ,针刺抽吸组最多行两次抽吸 ,第二次抽吸失败后改为量管引流 ,此类患者不包括在置管引流组。观察比较两组患者治疗结果、住院天数及并发症等 ,每 3天行超声检查。结果 :针刺抽吸组有效率6 6 6 7% ,置管引流组有效率 10 0 % ,有效治愈患者中 ,两种方法临床进展 (局部症状及体征缓解、体温下降、白细胞数正常 )所需平均时间及住院平均天数相似 (P >0 0 5 ) ,尽管针刺抽吸组脓腔直径由原来减小 5 0 %所需时间明显多于置管引流组 (13天 /6天 ) (P 0 0 5 ) ,但两组患者脓腔完全或近乎完全消失所需平均时间相似 (P >0 0 5 ) ,两组患者都未见主要并发症。结论 :从脓腔缩小 5 0 %所需时间及有效率来说 ,置管引流较针刺抽吸更有效。     

Percutaneous catheter drainage of tuberculous and nontuberculous psoas abscesses

Objective: To assess the utility of percutaneous catheter drainage in the management of tuberculous and nontuberculous psoas abscesses associated without any bony involvement or with minimal bony lesions that could not cause vertebral instability. Materials and method: Eleven patients with psoas, iliopsoas and pelvic abscesses were drained under computed tomography and ultrasono-graphy guidance. Results: There were 15 (10 tuberculous, 5 pyogenic) abscesses in 11 patients. Six of the tuberculous abscesses and one of the pyogenic abscess were associated with vertebral involvement. Vertebral lesions were located in one or two vertebrae without causing any serious disturbance in the vertebral stabilization. In one case, the abscess was bilateral. Nine cases were drained under computed tomography guidance, while two cases were drained under both computed tomography and ultrasonography guidance. One session drainage was sufficient for abscess resolution in uniloculated cases. In the two of four multiloculated cases, catheter drainage was performed twice. Relapse of the abscess was found in only one patient. The mean abscess volume was 520 ml and mean drainage duration was 12 days. None of the cases required surgery. Conclusion: Percutaneous drainage, chemotherapy and additional external brace application with the cases associated with bony lesion may be used for treatment of tuberculous and nontuberculous unilocule and multiloculated abscesses.     

Percutaneous drainage of tuberculous iliopsoas abscesses under image guidance

Most intra-abdominal and other types of fluid collections are now successfully drained percutaneously under image guidance. The utility of percutaneous drainage of tuberculous abscesses, especially those associated with osseous changes, is, however, less well established. Six patients with tuberculous iliopsoas abscesses were successfully managed by percutaneous drainage combined with antituberculous therapy. The abscesses were bilateral in one patient and unilateral in the other five. Drainage was by needle aspiration under ultrasound (US) guidance in one patient, and by catheter under CT guidance in the other patients. Three patients had associated osseous changes. There were no procedural complications. Tuberculous iliopsoas abscess can be successfully treated by percutaneous drainage and appropriate antituberculous therapy.