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PubMed1984

Extraperitoneal versus transperitoneal drainage of the intra-abdominal abscess.

Controversy as to whether the intra-abdominal abscess should be drained extraperitoneally or through formal laparotomy still rages. Arguments for a transperitoneal approach include no need to identify specific locus preoperatively and uniform drainage of all abscesses, especially any otherwise unrecognized pus collection. Proponents for the extraperitoneal route stress failure to contaminate previously uninvolved peritoneal spaces and more reliable avoidance of injury to intestine, predisposing to subsequent intestinal fistula. To resolve this impasse, a prospective study of each method was based upon a schedule of previously randomized treatment options. After 32 months of study, 60 patients had been enrolled without obvious differences between treatment groups with respect to demographic features, preoperative definition and locus of infection, precipitating cause of sepsis, associated diseases, responsible bacteria and antibiotic therapy. With the transperitoneal approach, five patients had hollow viscus injury, while seven eventually had an intestinal fistula develop, causing major problems in four. Despite no obvious intestinal injury with the extraperitoneal route, two transient intestinal fistulas did occur. Seven patients drained transperitoneally had additional abscesses discovered, yet another operation was required to drain at least one complicating abscess in seven of this same group. With the extraperitoneal route, only two patients needed reoperation to drain another abscess. Although there were more deaths and complications in the group drained transperitoneally, morbidity (47 per cent) and mortality (7 per cent) were not significantly different statistically. Such data refute the professed superiority of a transperitoneal approach to intra-abdominal abscess drainage, both from need to reoperative for second abscess as well as incidence of latter intestinal fistula. Best results were noted with abscess identification through computerized tomography followed by extraperitoneal drainage.

Abdomen↗
PubMed1991

Intra-abdominal abscesses in children.

Forty-one intra-abdominal abscesses in 30 Nigerian children seen over a 2-year period at the Obafemi Awolowo University Teaching Hospital were studied prospectively to determine their location, aetiology, microbiology and clinical course. Thirty-four abscesses (83%) were intraperitoneal with the subphrenic spaces and pelvis being the commonly involved intraperitoneal sites. Six abscesses (15%) were retroperitoneal while there was only one visceral abscess (2%). Diseases of the gastrointestinal tract occurring in 20 patients (67%) were responsible for the majority of intraperitoneal abscesses, while suppurating external iliac adenitis was the major cause of retroperitoneal abscesses. There were 62 microbiological isolates, with 52% being anaerobic bacteria and 47% aerobic bacteria. A fungus, Candida, was isolated once (2%). Escherichia coli and Staphylococcus aureus were the commonest aerobic bacteria, while Bacteroides and anaerobic streptococci were the commonest anaerobes. Sixteen patients (53%) had a mixed flora of aerobic and anaerobic bacteria, while in seven patients each (23%) only aerobic or anaerobic bacteria were isolated. The mortality rate in this series was 23%. Association of an intra-abdominal abscess with remote organ failure, postoperative anastomotic leakage, non-localization of the abscess within the peritoneal cavity and gastrointestinal perforation due to typhoid enteritis was found to portend poor prognosis.

Abscess↗
PubMed1980

Computed tomography in the diagnosis of abdominal abscess.

The CT features in 30 cases of suspected intra-abdominal abscesses are reviewed. The cases were grouped into proven (24), probable (4), and possible (2) abscess on clinical grounds, and were analyzed according to site within the abdomen. Two cases of carcinoma with fluid collections mimicking abscesses are also discussed. In the appropriate clinical context, abdominal abscess is identified on CT as a circumscribed low-density region within the abdomen. Subphrenic, hepatic, and splenic abscesses were readily recognized without contrast enhancement inthe majority of cases, although contrast enhancement consistently rendered loculation within hepatic abscesses more obvious. Aspiration and drainage under CT control were invaluable in diagnosis, permitting the identification of the causative organism in 18 cases. The precise anatomical detail provided by CT was important in achieving successful catheter placement for drainage.

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PubMed1985

Diagnosis of intra-abdominal abscesses. A review.

Intra-abdominal abscess, resulting either from primary intraperitoneal disease or as a complication of surgery, remains a serious problem with high patient mortality if not treated early and adequately. The initial attempt at diagnosis rests on strong clinical evidence supported by nonspecific laboratory findings. The most helpful advance over conventional x-ray studies has been the advent of noninvasive imaging techniques such as ultrasonography or computed tomography. Radioisotopic scanning with gallium or indium makes possible a generalized survey of the peritoneal cavity, but only after a delay from the time of injection. Ultrasonography is somewhat limited in utility, particularly in the left subphrenic space, and CT scanning remains the technique with highest resolution. These noninvasive imaging techniques also have the potential for directed percutaneous catheter drainage.

Abdomen↗
PubMed1985

Computed tomography: detecting intra-abdominal abscesses.

Detection of intra-abdominal abscesses by computed tomography (CT) has an estimated accuracy rate of greater than 90 percent. Features helpful in detecting these abscesses include extraluminal gas, the "rind" sign, airfluid interface, and low and high density areas. The author presents three cases to illustrate the usefulness of this modality.

Abdomen↗
PubMed1983

[Treatment of intra-abdominal abscesses by ultrasonically guided fine-needle puncture].

23 abdominal abscesses were diagnosed by ultrasound and confirmed by sonographically guided puncture. 18 cases were treated by an evacuating needle puncture and 5 cases by sonographically guided percutaneous drainage. In 12 out of 15 patients, fine needle puncture was curative without surgery required (80%). 2 out of 4 patients treated by percutaneous drainage had to be operated. Initially, 4 patients were operated, though after fine needle puncture or drainage a complete remission of symptoms and leukocytosis was observed. There were 2 complications: one hemorrhage leading to death following fine needle puncture of a pancreatic abscess and one temporary septicaemia. Sonographically guided fine needle puncture is simple and effective procedure in treatment of abdominal abscesses and should be considered as an alterative to surgery.

Abscess↗
PubMed1996

Percutaneous drainage of intra-abdominal abscesses using large lumen tubes under computed tomographic control.

OBJECTIVE: To describe our experience of percutaneous drainage of intra-abdominal abscesses with large-bore catheters under computed tomographic control. DESIGN: Retrospective study. SETTING: Teaching hospital, Greece. SUBJECTS: 185 Patients treated for abdominal abscesses during the period 1989-94. INTERVENTIONS: Needle aspiration (n = 27), drainage through conventional pigtail catheters (n = 22), and drainage through large-bore (8-16F) Argyle drains (n = 136). MAIN OUTCOME MEASURES: Morbidity. RESULTS: The overall success rate was 166/185 (92%). Of the 136 patients for whom the large-bore drains were used, 9 (7%) developed major complications (bowel fistula, n = 5; and pneumothorax and haemorrhage, n = 2 each) and 10 (7%) developed minor complications (obstruction of the tube, n = 4; dislocation of the tube, n = 3; bleeding from the wound, n = 2; and haematoma of the liver, n = 1). There were no deaths. CONCLUSION: Large-bore Argyle drains are efficient and safe for the percutaneous drainage of certain types of abdominal abscesses.

Abdominal Abscess↗
PubMed1991

Surgical versus percutaneous drainage of intra-abdominal abscesses.

The records of 83 patients with intra-abdominal abscesses treated between 1986 and 1990 were reviewed to determine if there were significant differences in the outcome of patients treated by surgical drainage (n = 41) or percutaneous drainage (n = 42). The two groups were matched for age, abscess location, and etiology. Parametric statistical evaluations included the Student's t test as well as analysis of variance; nonparametric statistics used were chi-square and Wilcoxon rank sums. No significant difference was found in mortality (surgical 14% versus percutaneous 12%) or morbidity (surgical 26% versus percutaneous 29%). The duration of hospital stay was similar. Although there was no significant difference between the two groups in severity of illness as measured by APACHE II scores, these scores were significant in determining prognosis. APACHE II scores were significantly higher in non-survivors of both groups (23 versus 13) and also higher in those developing complications. A subgroup of patients with diverticular abscess was identified in whom percutaneous drainage enabled later resection with primary anastomosis without complication. This study indicates that percutaneous drainage of an intra-abdominal abscess is as efficacious as surgical drainage and that APACHE II scores are prognostic of both potential mortality and morbidity.

Abdomen↗
PubMed2002

Computed tomography-guided percutaneous drainage of intra-abdominal abscesses in neutropenic children.

The mortality associated with undrained intra-abdominal abscesses is high. Computed tomography-guided percutaneous drainage (CT-PD), a minimally invasive technique, allows a drainage catheter to be inserted into fluid collections throughout the body with minimal risk. We described two neutropenic patients with intra-abdominal abscesses treated with CT-PD after they failed to respond to antimicrobial therapy. With this modality, the surgery was successfully avoided or delayed. We are of an opinion that CT-PD is an efficient and simple urgent radiology procedure.

Abdominal Abscess↗
PubMed1994

Computerized tomographic scan-guided drainage of intra-abdominal abscesses. Preoperative and postoperative modalities in colon and rectal surgery.

PURPOSE: Computerized tomographic (CT) scan-guided percutaneous drainage of intra-abdominal abscesses has changed the colon and rectal surgeon's approach to preoperative and postoperative intra-abdominal infections. This study is an effort to prove the efficacy of CT scan-guided percutaneous drainage. METHODS: A retrospective study was performed on 133 patients who underwent CT scan drainage of intra-abdominal abscesses over a 6.3-year period. RESULTS: 67 patients had underlying lower gastrointestinal disease. Twenty-three of these patients (34 percent) had spontaneous abscesses and underwent drainage as a preoperative or final modality, whereas 44 patients (66 percent) were drained postoperatively. In 78 percent of patients, surgery was successfully avoided or delayed. Ten patients had acute diverticulitis associated with a large pelvic abscess. Eight patients underwent successful CT scan-guided percutaneous drainage, yielding an 80 percent success rate. Morbidity from the CT scan-guided percutaneous drainage procedure in spontaneous and postoperative groups was 0 percent and 9 percent, respectively. Mortality was 9 percent and 11 percent, respectively, and associated with an elevated Acute Physiology and Chronic Health Evaluation II (APACHE II) score. CONCLUSION: CT scan-guided percutaneous drainage of intra-abdominal abscesses is an important adjunct to colon and rectal surgery because roughly 80 percent of spontaneous and postoperative abscesses were successfully managed.

Abdominal Abscess↗
PubMed1983

Abdominal abscess. A surgical strategy.

To reassess the role of laparotomy and extraserosal drainage in the treatment of patients with abdominal abscess, we analyzed the course of 79 patients who underwent 97 operations to treat 120 abdominal abscesses during a five-year period. In 66 clinical episodes the abscess was drained by the most direct approach. Sepsis resolved with a single operation In 80% of these patients, five patients (8%) required a second operation for drainage for an abscess, and eight patients (12%) died. In 31 clinical episodes, the abscess was drained by a laparotomy. Sepsis resolved with a single operation in 61% of these patients, seven patients (21%) had a second abscess, six patients (19%) required a second operation to drain a metachronous abscess, and six patients (19%) died. When the location or number of abscesses was diagnosed incorrectly, the success rate of therapy fell substantially. Since most abdominal abscesses can now be accurately diagnosed preoperatively, most abscesses should be drained by a direct approach. Exploratory laparotomy is indicated when preoperative localization is unsuccessful, when sepsis has not resolved after other methods of drainage, or when the patient has a concomitant abdominal condition that must be treated surgically.

Abdomen↗
PubMed1980

Upper abdominal abscess: a continuing and deadly problem.

Subphrenic and other upper abdominal abscesses continue to be associated with high mortality, even in today's era of broad spectrum antibiotics and sophisticated surgical techniques. Most cases represent complications of intraabdominal surgery. Because the clinical presentation is often subtle and nonspecific, the radiologist plays a paramount role in early diagnosis. Conventional radiography remains an effective method in the initial detection of upper abdominal abscesses. In this study, radiographs were reviewed in 82 patients. In retrospect, plain films revealed extraluminal gas or soft-tissue mass due to abscess in 58 patients (71%). Of these, the abscess was accurately reported initially in 42 patients, but it was initially missed in 16 patients. Conventional gastrointestinal contrast studies, which were underutilized, proved extremely accurate in demonstrating abnormality, especially in the left upper abdomen. Computed tomography, gallium scanning, and ultrasound were effective confirmatory procedures in many cases.

Abscess↗
PubMed2002

Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess.

HYPOTHESIS: Characteristics of intra-abdominal abscess can be used to predict successful outcome for percutaneous catheter drainage (PCD). METHODS: We performed a multicenter prospective study of patients who had intra-abdominal infections treated with PCD and intravenous antibiotics. Multivariate regression analysis determined predictors of successful outcome. RESULTS: The study included 96 patients (59% men; mean +/- SD age, 48 +/- 17 years; mean +/- SD Acute Physiology and Chronic Health Evaluation II score, 7.4 +/- 4.9). Postoperative abscess was present in 53% of patients. Isolated microorganisms included Bacteroides species (17%), Escherichia coli (17%), Streptococcus species (14%), Enterococcus species (10%), and fungi (11%). Single abscesses were present in 83% of patients. Computed tomographic guidance was used for drainage in 80% of patients, and ultrasound was used in 20%. The duration of abscess drainage was less than 14 days in 64%. Complete resolution of the infection with a single treatment of PCD was achieved in 67 patients (70%), and with a second attempt in 12 (12%). Thirty-three patients (34%) had PCD for the resolution of intra-abdominal sepsis prior to an elective, definitive procedure. Open drainage as a result of PCD failure was required in 15 (16%) and was more likely in patients with yeast (P<.001) or a pancreatic process (P =.02). Postoperative abscess (P =.04) was an independent predictor of successful outcome. CONCLUSIONS: Percutaneous catheter drainage of intra-abdominal infections was effective with a single treatment in 70% of patients and increased to 82% with a second attempt. A successful outcome is most likely with abscesses that are postoperative, not pancreatic, and not infected with yeast. Percutaneous catheter drainage is now a commonly used staging method for the resolution of intra-abdominal sepsis prior to corrective operation.

Abdominal Abscess↗
PubMed1992

Radiologic treatment of abdominal abscesses with fistulous communications.

Although percutaneous radiologic drainage of abdominal abscesses is now a well-established, standard procedure, several factors may limit its success. These limitations include the absence of a safe anatomic access route, presence of fistulous communications, and association with severe inflammation of organs such as the bowel or the pancreas. This review addresses advances and persisting limitations in the percutaneous management of complex abdominal abscesses.

Abdomen↗
PubMed1987

Indium-111-labelled leucocytes in the diagnosis of abdominal abscess.

The extensive morbidity and mortality of intra-abdominal abscess is mainly due to the delay in a diagnosis. The diagnostic accuracy of 111In-labelled mixed leucocytes with gamma imaging has been investigated in 100 consecutive patients including 34 following surgery and 36 with inflammatory bowel disease. White cell scans were performed 24 h following injection of autologous 111In-labelled leucocytes and were compared with clinical outcome where abscess was only diagnosed when pus either discharged or was drained at operation. Gamma images detected 28 of the 30 abscesses with no false positives giving 93 per cent sensitivity and 100 per cent specificity. Loculi of pus were identified in 11 of the 36 patients with inflammatory bowel disease with no errors in interpretation. Inflammation was reported in 15 of the remaining 25 patients with known but not necessarily active inflammatory bowel disease. 111In-labelled leucocyte imaging provides a rapid, safe and precise method for detecting intra-abdominal abscess even in the presence of inflammatory bowel disease.

Abscess↗
PubMed1994

Abdominal abscesses complicating peritonitis in continuous ambulatory peritoneal dialysis patients.

Ten patients with end-stage renal disease maintained on continuous ambulatory peritoneal dialysis therapy developed abdominal abscesses between 1982 and 1992. During this period, 537 patients cared for in our continuous ambulatory peritoneal dialysis unit developed 1,345 episodes of peritonitis. All abdominal abscesses were attributed to concomitant or antecedent peritonitis, suggesting that abscesses developed in 0.7% of peritonitis episodes. Abdominal pain, tenderness, fever, and nausea and vomiting were the most common presenting symptoms and signs. Radiographic findings that were helpful in establishing the diagnosis included abnormalities on computed tomography (CT) scanning, ultrasound, and Indium scanning. Seven patients developed intraperitoneal abscesses, two developed abdominal wall abscesses, and one developed both abdominal wall and intraperitoneal abscesses. Drainage of the abscesses was performed in all cases either surgically or percutaneously. Two patients died. The remaining eight patients have been maintained on hemodialysis therapy. The present data suggest that abdominal abscesses are uncommon complications of continuous ambulatory peritoneal dialysis-associated peritonitis. Prompt diagnosis by clinical criteria and radiographic techniques is important to permit appropriate drainage of the abscess cavity.

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PubMed2001

[Ultrasound-controlled minimally invasive surgical interventions in abdominal abscesses].

Results of ultrasound-controlled minimally invasive surgical interventions (UAMISI) for abdominal abscesses are analyzed. 84 operations were performed in 72 patients with good results. Puncture method was used in 12 patients, drainage operation--in 58, endoscopy-guided puncture method--in 2 patients. Indications for different ultrasonic-assisted interventions are developed. It is concluded that at present the UAMISI are the alternative to conventional "open" treatment of abdominal abscesses.

Abdominal Abscess↗
PubMed1978

Giant lymph node hyperplasia resembling abdominal abscess on gallium scan.

A case of giant lymph node hyperplasia with systemic symptoms resembling chronic infection is described which showed intense gallium uptake indistinguishable from uptake seen in an abscess. This rare syndrome may mimic an abdominal abscess and should be considered in the differential diagnosis of patients without prior history of abdominal surgery and in whom an abdominal abscess is suspected. The condition is relatively benign.

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