Percutaneous Abscess Drainage: Update

Abstract

During the approximately 20 years that percutaneous abscess drainage (PAD) has been an extant procedure and as the millennium begins, PAD has become, by consensus, the treatment of choice for abscesses. Indications for PAD continue to expand, and currently almost all abscesses are considered amenable. On occasion, PAD is an adjunctive procedure that provides a beneficial temporizing effect for the surgeon who eventually must operate for a coexisting problem such as a bowel leak. Simple unilocular abscesses are cured almost uniformly by PAD; more complicated abscesses, such as those with enteric fistulas (e.g., diverticular abscess) or pancreatic abscesses, have cure rates ranging from 65% to 90%. Various catheters and insertion techniques have proven effective. Ultrasonography, computed tomography, and fluoroscopy are the staple modalities that guide PAD. PAD is the prototype interventional radiology procedure, providing detection of the abscess by imaging, needling for diagnosis, and catheterization for therapy.

Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

“…Ultrasound (US) or computed tomography (CT) guided placement of drainages is reported to be effective in up to 90% for drainage of fluid collections or abscesses with purely liquid content [14] . However, the success rates…”

“…Thus, in the last decade minimal invasive treatment regimes and in particular percutaneous drainage therapy were included in the management of infected necrotizing pancreatitis. Ultrasound (US) or computed tomography (CT) guided placement of drainages is reported to be effective in up to 90% for drainage of fluid collections or abscesses with purely liquid content [14] . However, the success rates Abstract AIM: To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number.…”

Effect of a Single Percutaneous Abscess Drainage Puncture and Imipenem Therapy, Alone or in Combination, in Treatment of Mixed-Infection Abscesses in Mice

“…Although the increase in the weights of both undrained and drained abscesses was probably due to an ongoing inflammatory response, the host defenses were, presumably, unable to cope with the large numbers of bacteria remaining in the abscesses (8). Since repeated percutaneous drainage punctures could not be performed in this animal model, it should be emphasized that, with the routine practice of continuous catheter drainage procedures (19), the elimination of pus (and bacteria) in the clinical setting would probably be more efficient than was possible in this study with a single puncture. Nevertheless, these results demonstrate the consequences of inadequate bacterial removal.…”

Intra-abdominal abscesses – current diagnosis and therapy

“…Przykładem jest pęknięty wrzód trawienny żołądka lub dwunastnicy, perforacja w przebiegu zapalenia wyrostka robaczkowego, wrzodziejącego zapalenia jelita grubego lub uchyłka jelita grubego [1][2][3]. Podobnie często ropnie powstają w wyniku zgorzelinowego zapalenia pęcherzyka żółciowego, ostrego zapalenia trzustki z zakażoną martwicą narządu, martwicy przewodu pokarmowego w przebiegu niedokrwienia i uwięźnięcia [1][2][3][4].…”

“…Przykładem jest pęknięty wrzód trawienny żołądka lub dwunastnicy, perforacja w przebiegu zapalenia wyrostka robaczkowego, wrzodziejącego zapalenia jelita grubego lub uchyłka jelita grubego [1][2][3]. Podobnie często ropnie powstają w wyniku zgorzelinowego zapalenia pęcherzyka żółciowego, ostrego zapalenia trzustki z zakażoną martwicą narządu, martwicy przewodu pokarmowego w przebiegu niedokrwienia i uwięźnięcia [1][2][3][4]. Do kolejnych przyczyn zalicza się ostre stany chorobowe dróg rodnych, urazowe uszkodzenie narządów wewnątrzbrzusznych i przewodu pokarmowego, powikłania pooperacyjne (przetoka, martwica) oraz zakaże-nia krwiopochodne narządów miąższowych jamy brzusznej [1][2][3][4][5].…”