Percutaneous drainage

Pancreatic abscess is a collection of pus that forms in the pancreas 4 to 6 weeks after acute pancreatitis. Pancreatic abscess is usually less life-threatening than pancreatic necrosis or pancreatic pseudocyst and can be managed with percutaneous drainage.5... 

Treatment regimens for intraabdominal infection can be judged as successful if the patient recovers from the infection without recurrent peritonitis or intraabdominal abscess and without the need for additional antimicrobials. A regimen can be considered unsuccessful if a significant adverse drug reaction occurs, reoperation or percutaneous drainage is necessary, or patient improvement is delayed beyond 1 or 2 weeks. 

Bosanac, Z. B., Lisanin, L. Percutaneous drainage of hydatid cyst in the liver as a primary treatment Review of 52 consecutive cases with long-term follow-up. Clin. Radiol. 2000 55 839-848... 

Filice, C., Brunetti, E., Bruno, R., Crippa, F.G Percutaneous drainage of echinococcal cysts (PAIR-puncture, aspiration, injection, reaspiration) results of a worldwide survey for assessment of its safety and efficacy. Gut 2000 47 156-157... 

Friedman, E., Biahut, R.J., Bender, M.D. Hepatic abscesses and funge-mia from Torulopsis glabrata. Successful treatment with percutaneous drainage and amphotericin B. J. Clin. Gastroenterol. 1987 9 711—715... 

Percutaneous drainage was initially attempted by A. F. S Mac-Fadzen et al. in 1953. It was later introduced into clinical routine by IR. Haaga et al. (1976) (s. tab. 7.2) using the CT-guided method. An improved technique was applied by S.G. Gerzof et al. (1981) and proved very successful in the treatment of liver abscesses. 

Percutaneous drainage may be limited by antelocated intestinal loops or by abscesses that are difficult to reach. Similarly, surgery is indicated following unsuccessful percutaneous drainage, in extensive cavernous or multifocal abscesses, tissue sequestration, formation of enteral fistula and viscous abscess contents as well as local recurrences. With abscess perforation or the existence of other purulent foci in the abdomen, surgical intervention is called for immediately. 

Bertel, C.K., van Heerden, JA., Sheedy, P.F. Treatment of pyogenic hepatic abscesses, surgical vs percutaneous drainage. Arch. Surg. 1986 121 554-558... 

Civardi, G., Filice, C., Caremani, M., Giorgio, A. Hepatic abscesses in immunocompromised patients ultrasonically guided percutaneous drainage. Gastrointest. Radiol. 1992 17 175-178... 

Gerzof, S.G., Johnson, W.C., Robbins, A.H., Nabseth, D.C. Intrahepa-tic pyogenic abscesses treatment by percutaneous drainage. Amer. J. Surg. 1985 149 487-494... 

Lambiase, R.E., Deyoe, L., Cronan, J.J., Dorfman, G.S. Percutaneous drainage of 335 consecutive abscesses results of primary drainage with 1-year follow-up. Radiology 1992 184 167-179... 

McDonald, M.I., Corey, G.R., Gallis, H.A., Durack, D.T. Single and multiple pyogenic liver abscesses. Natural history, diagnosis and treatment, with emphasis on percutaneous drainage. Medicine (Baltimore) 1984 63 291-302... 

Wong, K.-R Percutaneous drainage of pyogenic liver abscesses. World J. Surg. 1990 14 492- 497... 

Himal, H.S., Lindsay, X Ascending cholangitis surgery versus endoscopic or percutaneous drainage. Surgery 1990 108 629-634... 

A nnmber of drainage techniqnes have been described nsing endoscopy and laparoscopy. These minimal-access techniques may offer advantages when compared with traditional surgery but probably wiU be used less often than radiologically assisted percutaneous drainage techniques. 

CT is only used to evaluate complications, when US is inconclusive or percutaneous drainage is required (Parker 2003 Devos and Merdji 2003). 

Thomas KT, Bream PR Jr, Berlin J, Meranze SG, Wright JK, Chari RS (2004) Use of percutaneous drainage to treat hepatic abscess after radiofrequency ablation of metastatic pancreatic adenocarcinoma. Am Surg 70 496-499... 

Lamaris JS,Stoker J,Dees Jet al (1987) Nonsurgical palliative treatment of patients with malignant biliary obstruction. The place of endoscopic and percutaneous drainage. Clin Radiol 38 603-608... 

A small perinephric hematoma is common but active intervention is rarely necessary. However, an infected hematoma, resulting in a perirenal abscess, requires percutaneous drainage. 

The indication for percutaneous drainage of (non)in-flammatory fluid collections should always be discussed in a multidisciplinary team, i.e., between the radiologist... 

Renal Abscess. Indications for percutaneous drainage of renal fluid collections are perinephric and large intra-renal abscesses, as well as small intrarenal abscesses not responding to antibiotic therapy. Another indication are infected urinomas, which are treated by a single percutaneous drainage, or in combination with additional nephrostomy when a communication between the uri-noma and the urinary collecting system persists. 

Pancreatic necrosis occurs in patients with severe acute pancreatitis detected through perfusion defects in the contrast-enhanced CT. Therapeutic method of choice is surgical necrosectomy percutaneous drainage is not suitable. On the other hand, the differentiation of sterile from infected pancreatic necrosis is done by percutaneous sampling of the necrotic pancreatic parenchyma with a small-gauge needle (20 G). 

GI or bihary tract. Preinterventional contrast-enhanced CT performed in an arterial and venous phase enables the operator to differentiate clearly surrounding organs and vessels. A transgastric approach may be chosen for placement, which can be later used for transgastric stent placement (internal drainage) between the pseudocyst and the stomach. In case the pseudocyst communicates with the pancreatic duct, duration of percutaneous drainage may take up to 8-12 weeks. 

Hashimoto et al. (1995) reported 56 cases of pyogenic liver abscesses 39 and 10 patients underwent CT-guided drainage or simple aspiration without drainage, respectively. Six patients were treated with open operative drainage, while one patient with advanced cancer only received antibiotics. Five of 39 patients had to undergo operation after primary percutaneous drainage (87% success rate). Overall mortality rate was 12.5% (7/56). 

Cantasdemir et al. (2003) reported their experience with CT-guided percutaneous drainage in 21 patients with iliopsoas abscesses, which were technically successful in 21/22 cases. Nineteen and three procedures were performed with the Trocar and Seldinger tech-... 

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