Drainage of Post-Operative Abdominal and Pelvic Abscesses under the Guidance of Computed Tomography

Abstract

BACKGROUND: Cross sectional imaging and specifically computed tomography (CT) has become the main radiological modality of detecting post-surgical abdominal collections and abscesses. Percutaneous abscess drainage (PAD) has revolutionized the treatment of abscesses, especially of post-surgical abdominal abscesses over the last 25 years; repeat laparotomy is a rare event due to the fact that the success rate of PAD is very high (90-95%) and complications are few (0-10%).

OBJECTIVE: The aim of the study is to present our experience in the department of computed tomography of the percutaneous drainage of post-operative abdominal and pelvic abscesses.

PATIENTS AND METHODS: During the last two and a half years, 93 post-operative patients were referred to the CT department for drainage of a post-surgical abscess in the abdomen or pelvis at 9-21 days post-operatively due to persistent fever. A total of 95 abscesses were drained; 84 were located in the abdomen and 11 in the pelvis. Abscess diameters ranged between 2 and 12 cm.  A percutaneous drainage technique under CT-guidance was employed in all patients; 98 catheters were placed with use of the Seldinger technique.  A transgluteal paracoccygeal approach was adopted in 11 patients. Aspiration of an intra-loop abscess was performed in 1 patient. The tilted gantry technique was utilized in 2 cases.

RESULTS: Eighty-nine (95.7%) patients were successfully treated. In 4 (4.3%) patients the abscesses were partially drained, patients were stabilized and subsequently treated via laparotomy. Complications included inflammation of the skin at the entry site in 4 patients, pneumothorax in 1 patient, and displacement of the catheter in 12 patients, one involving catheter migration into the duodenum.  Major complications did not occur.

CONCLUSION: Percutaneous drainage of post-operative abdominal and pelvic abscesses was a safe and effective method of abscess management in our series with a 95.7% success rate and absent major complications. It is currently a widely used procedure, eliminating the need for repeat laparotomy in the majority of patients. Proper catheter management is essential for the successful outcome.