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BackgroundTo explore the safety and efficacy of several special approaches of drainage for deep inaccessible intraabdominal and pelvic abscesses.MethodsBy searching of our institutional database, the clinical and radiologic information of all patients with special approaches of abscesses drainage was collected, consisting of etiology, diameter of abscess, duration of drainage, major complications, rates of success, failure and death, and pre-procedure, intra-procedure and post-procedure computed tomography scans.ResultsA total of 124 patients are eligible for the criterion in our center between January 2010 and January 2018. The mean diameter of abscess was 5.6 cm (range 3.0–9.8 cm) and mean duration of drainage was 10.3 days (range 4–43 days). Pain was complained in 6 patients (4.8%) and hemorrhage was observed in one patient. Complete resolution of the abscess following drainage was observed in 115 patients (92.7%). A total of 9 patients (7.3%) failed to percutaneous abscess drainage and 3 patients died of catheter-unrelated diseases. Transintestinal afferent loop of drainage was firstly attempted in six patients and complete resolution of abscess was achieved in five patients.ConclusionSpecial approaches, including transgluteal, presacral space, transhepatic, multiplane reconstruction (MPR)-assisted oblique approach and transintestinal afferent loop approach for those deep inaccessible intraabdominal and pelvic abscesses are safe and feasible.

Trial Design: The aim of this study was to identify independent risk factors for post-pancreatoduodenectomy (post-PD) abdominal fluid collections (AFCs) and evaluate our management protocol on it. Methods: A retrospective analysis of consecutive 2064 cases who underwent PD over the past decade in 1 single center was conducted. The patients were divided into AFCs and non-AFCs group. Univariable and multivariate logistic regression analysis was performed to identify independent risk factors of AFCs. The AFCs group was compared with the non-AFCs group with respect to the incidence of postoperative outcomes. The characteristics of AFCs were further analyzed in terms of clinical manifestations. Results: Two thousand sixty-four cases with pancreaticoduodenectomy were recruited and 15% of them were found AFCs. Diameter of main pancreatic duct ≤3 mm was found to be an independent predictor of AFCs ( P < .001), along with soft pancreatic texture ( P = .002), mesenterico-portal vein resection ( P < .001), and estimated intraoperative blood loss >800 mL (P < .001). The incidence of mild complications was significantly higher in AFCs group than in non-AFCs group (34% vs 20%, P < .001), whereas no significant differences were noted in the rate of severe complications between these 2 groups (15% vs 15%, P = .939). Conclusion: Enhanced drainage is recommended as an effective measure to decrease the incidence of severe complications caused by post-PD AFCs.

Background Firearm-related injuries are the second leading cause of death among US children. Given this, firearm injury prevention should be a key aspect of pediatric anticipatory guidance. Objective We assessed the impact of a firearm safety counseling workshop on pediatric resident knowledge, self-efficacy, and self-reported practice patterns. Methods Sixty of 80 residents (75%) participated in a 2-hour multimodal workshop, including video, didactics with experts, and role-play scenarios. Participants were invited to complete pre-workshop, immediate post-workshop, and 3- and 6-month post-workshop self-reported questionnaires evaluating knowledge, comfort, perceived barriers, and reported practice patterns. Data comparing pre- and 6-month post-workshop practice patterns were analyzed via Fischer's exact test. Remaining statistical analysis utilized a one-sided, unpaired Mann–Whitney U test. A binomial exact proportions test was used for open-ended responses. Results After the workshop, the percentage of participants with perceived concern regarding parental barriers decreased significantly (24% to 7%, P = .001). Participants 6 months post-workshop were 5.14 times more likely to counsel their patients on firearms during more than 75% of their well visits than prior to the intervention ( P = .010). Participants reported greater comfort asking patients about firearms, with mean Likert scores increasing from 3.81 pre to 4.33 post ( P = .022), which was similar to 3-month (4.39, P = .06) and 6-month evaluations (4.54, P = .003). Conclusions Education on firearm safety counseling improved pediatric resident comfort level in discussing the topic. This impact persisted 6 months after the workshop, implying a sustained change in attitudes and behaviors.