Percutaneous drainage of 101 pancreatic pseudocysts (51 infected, 50 noninfected) in 77 patients is described. In this group of patients, 91 of 101 pseudocysts were cured by means of catheter drainage (90.1%) (noninfected, 43 of 50 [86%]; infected, 48 of 51 [94.1%]). Six patients underwent operation after percutaneous treatment due to persistent drainage. In patients with infected pseudocysts, the infection was eradicated by percutaneous drainage before operation. Four pseudocysts recurred and were redrained percutaneously. The mean duration of drainage was 19.6 days (infected pseudocysts, 16.7 days; noninfected, 21.2 days). Various access routes were used for catheter drainage: transperitoneal, retroperitoneal, transhepatic, transgastric, transduodenal, and transsplenic (inadvertent). Four major (superinfections) and six minor complications occurred. An unexpected finding in seven patients was spontaneous fistulization of the pseudocyst into the gastrointestinal tract. Percutaneous drainage is an effective front-line treatment for most pancreatic pseudocysts; cure is likely if fluid collections are drained adequately and if sufficient time is allowed for closure of fistulas from the pancreatic duct.

Lung abscesses were drained by means of catheters guided by computed tomography (CT) in 19 patients who still had sepsis despite standard medical therapy; all patients had received antibiotics for at least 5 days, and 11 of the 19 patients had undergone bronchoscopy. The abscess was cured (by clinical and radiographic criteria) in all 19 patients (100%), and surgery was avoided in 16 of the 19 patients (84%). Three patients underwent surgery for removal of organized tissue or decortication after the lung abscess was evacuated. Complications included a hemothorax that required a chest tube in one patient and three minor complications (a clogged catheter in two patients and transient elevation of intracerebral pressure in one patient). The hemothorax occurred in one of two patients in whom the catheter traversed normal lung. The percutaneous drainage catheters traversed juxtaposed abnormal pleura on route to the abscess in 17 of the patients. CT-guided drainage of lung abscess is an effective method to treat lung abscesses that are refractory to conventional therapy; the procedure should obviate major operation in most patients. A catheter route through abscess-pleural syndesis is preferable, and CT is useful for planning this route.

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This report summarizes diagnostic and therapeutic radiologic procedures inThe operation generally is well tolerated, particularly in young and middle-aged patients. Morbidity is reported to be from 4% to 32% in several large surgical series,'. 3-8 whereas mortality rates vary from 0.4% to 2.5%.1-6, The most frequent complications of chole- 11/56/18794cystectomy are wound infection, abscess formation, ductal injury or ligation, and bleeding.3, "-") Elderly patients undergoing emergency cholecystectomy are more prone to complications and serious sequelae; their mortality rate is approximately double that of young During the past 4 years, we have performed interventional radiologic procedures in 45 patients to diagnose and treat serious complications of cholecystectomy. This report describes the spectrum of these procedures and the benefits of interventional radiology for the surgeon in the treatment of these patients. MATERIAL AND METHODSThe 45 patients who underwent cholecystectomy include 34 women and 1 1 men whose ages range from 19 to 82 years. Complications were appreciated at the time SURGERY 826

Percutaneous cecostomy (PCC) was evaluated in dogs and cadavers and by means of review of intraperitoneal contrast material-enhanced computed tomographic (CT) scans and clinical experience in five patients with Ogilvie syndrome. It was shown that PCC can be accomplished with a variety of techniques (e.g. Seldinger or trocar puncture, tacking) and instruments (various types and sizes of retention and nonretention catheters). Anatomic studies revealed that the cecum is surrounded by the peritoneum for as much as 270 degrees of its circumference, so that a retroperitoneal approach to PCC would probably be unfeasible in most patients. PCC was effective in treating all five patients in this study, despite their advanced age and complicated medical conditions. Decompression of colonic gas was achieved with 8-12-F catheters, and no major complications occurred. Endoscopic decompression had been unsuccessfully attempted in four of the patients previously. It is concluded that PCC may be an important option in the treatment of Ogilvie syndrome and that the procedure may obviate surgery and be lifesaving in certain high-risk patients.