Postoperative abscesses with enteric communication: percutaneous treatment.

Abstract

Patients with abscesses that have enteric communication in the absence of underlying inflammatory bowel disease require modification of the usual percutaneous treatment techniques. An ongoing source of output (gastrointestinal secretions) is a complicating factor in treatment. The results of percutaneous treatment of 17 abscesses with enteric communication in 16 patients without a history of inflammatory bowel disease were reviewed. The long-term cure rate was 71%. Pancreatic involvement in abscess-bowel communication diminished the cure rate to 50% (two of four) and lengthened the duration of drainage required. The results suggest that percutaneous treatment of abscesses with enteric communication is a viable alternative to surgical intervention. Minimal morbidity and no mortality were directly attributable to percutaneous therapy in this series. When the pancreas is involved in the establishment or persistence of the abscess-bowel communication, or when the underlying bowel is diseased, the rate of success decreases.

Imaging for Infection: From Visualization of Inflammation to Visualization of Microbes

“…However, because of the short half-life of 18 F (110 min), delayed imaging that is necessary to observe leukocyte trafficking is not possible. Thus, 64 Cu-WBCs are more likely to be useful because the long half-life of 64 Cu (12.7 h) allows for imaging up to 18-24 h after reinjection in patients.…”

“…In these cases, gallium scanning has traditionally been utilized, but more recently has included use of 18 F-FDG-PET. The above ex vivo techniques for labeling WBC are accurate, however, the process involved in radiolabeling WBCs is tedious and requires strict sterile conditions.…”

“…Uniloculated collections with no fistulous connection to the gastrointestinal tract or bronchial tract are likely to be resolved by percutaneous drainage. Complex collections, particularly those complicated by tissue liquefaction or local hematoma are more likely to require surgical intervention [16][17][18].…”

“…It was soon noted that FDG also accumulates in areas of infection due to high glucose uptake and utilization by leukocytes. The glucose analogue FDG is transported into activated leukocytes by the same glucose transporters used by glucose, where it undergoes phosphorylation by hexokinase to become 18 F-FDG-6-phosphate. This molecule is trapped inside the cell because it cannot proceed down the glycolytic pathway nor can it exit the cell via the usual glucose transport proteins.…”

“…In work-up of FUO, 18 F-FDG-PET/CT has emerged as a test of choice, especially with the anatomic details afforded by the accompanying cross-sectional imaging [30]. Gallium scanning remains favored for imaging of chronic osteomyelitis, spondylitis, and spondylodiscitis [46].…”