Postoperative fluid collections after colon resection: the utility of clinical assessment

Sarkissian, Hagop; Hyman, Neil; Osler, Turner M.

doi:10.1016/j.amjsurg.2013.01.031

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…We studied the outcome of CT fluoroscopy-guided drainage of deep pelvic fluid collections in patients after colorectal surgery over a period of 16 years. Abdominal fluid collections are a common complication and occur in up to 6% of the cases [33]. In the minority of cases, fluid collections after colorectal surgery may be superinfected due to underlying anastomotic leakages in addition to usual causes for sterile collections such as hematomas, seromas, etc.…”

Section: Discussionmentioning

confidence: 99%

Low-Dose CT Fluoroscopy-Guided Drainage of Deep Pelvic Fluid Collections after Colorectal Cancer Surgery: Technical Success, Clinical Outcome and Safety in 40 Patients

et al. 2023

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Purpose: To assess the technical (TS) and clinical success (CS) of CT fluoroscopy-guided drainage (CTD) in patients with symptomatic deep pelvic fluid collections following colorectal surgery. Methods: A retrospective analysis (years 2005 to 2020) comprised 43 drain placements in 40 patients undergoing low-dose (10–20 mA tube current) quick-check CTD using a percutaneous transgluteal (n = 39) or transperineal (n = 1) access. TS was defined as sufficient drainage of the fluid collection by ≥50% and the absence of complications according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). CS comprised the marked reduction of elevated laboratory inflammation parameters by ≥50% under minimally invasive combination therapy (i.v. broad-spectrum antibiotics, drainage) within 30 days after intervention and no surgical revision related to the intervention required. Results: TS was gained in 93.0%. CS was obtained in 83.3% for C-reactive Protein and in 78.6% for Leukocytes. In five patients (12.5%), a reoperation due to an unfavorable clinical outcome was necessary. Total dose length product (DLP) tended to be lower in the second half of the observation period (median: years 2013 to 2020: 544.0 mGy*cm vs. years 2005 to 2012: 735.5 mGy*cm) and was significantly lower for the CT fluoroscopy part (median: years 2013 to 2020: 47.0 mGy*cm vs. years 2005 to 2012: 85.0 mGy*cm). Conclusions: Given a minor proportion of patients requiring surgical revision due to anastomotic leakage, the CTD of deep pelvic fluid collections is safe and provides an excellent technical and clinical outcome. The reduction of radiation exposition over time can be achieved by both the ongoing development of CT technology and the increased level of interventional radiology (IR) expertise.

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Section: Discussionmentioning

confidence: 99%

Low-Dose CT Fluoroscopy-Guided Drainage of Deep Pelvic Fluid Collections after Colorectal Cancer Surgery: Technical Success, Clinical Outcome and Safety in 40 Patients

et al. 2023

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“…A retrospective study looking at postoperative patients after colorectal resection revealed that nearly 75% of patients with clinical concern for an infection will have a fluid collection, but many of these will not represent abscesses. Of the clinical, laboratory, and radiologic parameters studied, only a high index of clinical suspicion and close proximity of the fluid collection to the site of surgery were associated with predicting an infected collection [52]. In a retrospective review of elective pancreatic resections, intra-abdominal infections were diagnosed at a mean of 11.8 days following the procedure; notably, abdominal pain and peritonitis were uncommon presentations and early postoperative CT was encouraged in any patient presenting with fever and sepsis [53].…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain

Scheirey

Fowler

Therrien

et al. 2018

Journal of the American College of Radiology

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The range of pathology in adults that can produce abdominal pain is broad and necessitates an imaging approach to evaluate many different organ systems. Although localizing pain prompts directed imaging/management, clinical presentations may vary and result in nonlocalized symptoms. This review focuses on imaging the adult population with nonlocalized abdominal pain, including patients with fever, recent abdominal surgery, or neutropenia. Imaging of the entire abdomen and pelvis to evaluate for infectious or inflammatory processes of the abdominal viscera and solid organs, abdominal and pelvic neoplasms, and screen for ischemic or vascular etiologies is essential for prompt diagnosis and treatment. Often the first-line modality, CT quickly evaluates the abdomen/pelvis, providing for accurate diagnoses and management of patients with abdominal pain. Ultrasound and tailored MRI protocols may be useful as first-line imaging studies, especially in pregnant patients. In the postoperative abdomen, fluoroscopy may help detect anastomotic leaks/abscesses. While often performed, abdominal radiographs may not alter management.

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“…The CT scans, however, do not necessarily differentiate infected from uninfected post-operative fluid collections [646][647][648]. The CT scans may also be less useful for detecting infections because of early anastomotic leaks [649,650]. It has generally been accepted that the utility of contrast-enhanced CT scans increases the longer it is after initial source control.…”

Section: Agentmentioning

confidence: 99%

The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection

Mazuski

Tessier

May

et al. 2017

Surgical Infections

455

426

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Postoperative fluid collections after colon resection: the utility of clinical assessment

Cited by 7 publications

References 25 publications

Low-Dose CT Fluoroscopy-Guided Drainage of Deep Pelvic Fluid Collections after Colorectal Cancer Surgery: Technical Success, Clinical Outcome and Safety in 40 Patients

Low-Dose CT Fluoroscopy-Guided Drainage of Deep Pelvic Fluid Collections after Colorectal Cancer Surgery: Technical Success, Clinical Outcome and Safety in 40 Patients

ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain

The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection

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