Non-traumatic abdominal emergencies: imaging and intervention in sepsis

Abstract

Cross-sectional imaging, in particular CT, has become the main method of detecting abdominal collections. Indium-labelled white-cell scintigraphy and gallium scintigraphy are reserved for patients in whom there is a high clinical suspicion of abdominal sepsis but CT has not revealed a source of sepsis. Scintigraphy is also used in patients with suspected vascular graft infections or suspected infected hip prostheses. Percutaneous abscess drainage (PAD) has revolutionised the treatment of abdominal abscesses over the past 20 years, with repeat laparotomy for postoperative abscesses becoming a rare event. Ultrasound or CT can be used to guide PAD. Choosing an access route that does not cross intervening organs is of crucial importance to the safe performance of PAD. The Trocar or Seldinger techniques can be used with equal success. The cavity should be aspirated until dry and irrigated with saline. Repeat imaging after drainage is helpful to detect any undrained locules. PAD endpoints include patient defervescence, reduction in white blood cell count and catheter drainage of less than 10 ml per day. Details regarding PAD in specific abdominal regions are discussed. Success rates for PAD are high (close to 90%) in most abdominal organs. Slightly lower success rates are seen with PAD of pancreatic abscesses and abscesses associated with fistulas (60-85% success rates). Complication rates lie between 0% and 10%. Complications can be minimised by ensuring that the patient has broad spectrum antibiotic coverage before drainage, by carefully planning the access route and by ensuring diligent post-procedure care by radiology staff.

The Labeled-Leukocyte Scan in the Study of Abdominal Abscesses

“…More importantly, percutaneous drainage of the collection under CT or US guidance is now the preferred method of dealing with such complications as it prevents unnecessary surgery reducing morbidity and hospital in-stay [43,44]. In a comparison study on the usefulness of CT compared to LS in detecting abdominal collections, Lee [45] emphasized that CT is the main method for diagnosis while LS is reserved for patients in whom there is a high clinical suspicion of abdominal Accessibility to an expert radiologist and/or other specialist able to study all of the abdomen (inclusive of bowel and retroperitoneal spaces) and to immediately perform percutaneous aspiration of intra-abdominal fluid collections US is the initial investigation to be performed sepsis, but in whom CT has not revealed a source of sepsis. The most important studies that have compared at least two imaging modalities with LS in the detection of abdominal abscess are summarized in Table 2.…”

Abdominal abscess and Hafnia alvei septicemia occurring during the aplastic phase after autologous stem-cell transplantation in a patient with diffuse large B-cell lymphoma

“…20,21 Recently, however, other unusual organisms, such as Enterobacter and fungi, have been reported as causative agents. 20,21 Although the signs and symptoms of abdominal abscess have been well described, they are not specific in neutropenic patients, and so this kind of abscess remains a diagnostic challenge. This is especially true in neutropenic patients who are known to be febrile for other more common reasons.…”

“…Other imaging techniques, such as gallium scans and indium-labeled whiteblood-cell scans can be used for more accurate diagnosis and localization. 21 Because aplastic patients have a very high surgical risk, the first therapy attempt could be conservative, with antibiotics plus G-CSF, reserving surgical options or other invasive treatments (such as CT-guided percutaneous catheter drainage) for those cases that do not respond to antimicrobial therapy. 22 To our knowledge, the case we reported is the first one to be described in the literature of H. alvei septicemia with an abdominal abscess in a hematologic patient following autologous PBSCT.…”

“…If not promptly recognized and treated, abdominal abscess may rupture locally into the peritoneal and retroperitoneal space or into the pleural cavity, with a high mortality rate. 21 The diagnosis is usually made by US or CT scan and/or magnetic resonance imaging (MRI). Other imaging techniques, such as gallium scans and indium-labeled whiteblood-cell scans can be used for more accurate diagnosis and localization.…”

Diagnostic Imaging of the Critically Ill Obese Patient

“…In addition, obese patients have greater risk of developing sepsis after surgery due to impaired wound healing related to poorly vascularized adipose tissue, and an increased incidence of diabetes mellitus and hyperglycemia [13] . CT and ultrasound are common imaging modalities used; in particular, CT has been the mainstay technique for detecting intraabdominal fluid collections (Figure 16.7 ) [26] . CT and ultrasound are common imaging modalities used; in particular, CT has been the mainstay technique for detecting intraabdominal fluid collections (Figure 16.7 ) [26] .…”