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PubMed1981

Non-surgical drainage of intra-abdominal and mediastinal abscesses: a report of twelve cases.

Twelve patients with intra-abdominal or mediastinal abscesses were treated by percutaneous drainage. Three abscesses were subphrenic, three were adjacent to enteric leaks, two were intrahepatic, two were pancreatic pseudocysts, one was a pancreatic abscess extending to the lesser sac, and one was an infected adrenal hematoma. All 12 lesions were entered percutaneously using fluoroscopic guidance without traumatizing the adjacent normal tissue. Localization was frequently aided by computed tomography. Various catheters were positioned using basic angiographic techniques. Following drainage all patients had a favorable clinical response. Seven of the 12 patients required no surgical management. Careful radiologic follow-up and frequent changing of catheters was necessary in six of the patients. Two patients benefited from the addition of auxiliary drains. Five of the 12 patients were electively operated upon because of incomplete drainage of the abscess cavity. Causes of failure were: persistent anastomotic leak (two patients), sequestered, loculated extension of abscess cavity (two patients), or necrotic, viscous hepatic tissue requiring removal at laparotomy (one patient).

Abscess↗
PubMed2004

Intra-abdominal, retroperitoneal, and visceral abscesses in children.

This review describes the microbiology, diagnosis, and management of intra-abdominal abscesses (including subphrenic, hepatic, splenic, and retroperitoneal abscesses) in children. They often occur as a complication of local or generalized peritonitis, commonly secondary to appendicitis, necrotizing enterocolitis, pelvic inflammatory disease, and tubo-ovarian infection, surgery or trauma. The original infection generally occurs because of the entry of enteric microorganisms into the peritoneal cavity through a defect in the wall of the intestine or other viscus as a result of obstruction, infarction, or direct trauma. Mixed aerobic and anaerobic flora can be recovered from most abscesses. The predominant aerobic isolates are Escherichia coli, Staphylococcus aureus, and Enterococcus spp. and the main anaerobic bacteria are Bacteroides fragilis group Peptostreptococcus spp., Fusobacterium spp., and Clostridium spp. The treatment of intraabdominal abscesses includes drainage, surgical correction of pathology, and administration of antimicrobials effective against both aerobic and anaerobic microorganisms.

Abdomen↗
PubMed1991

[Treatment of hepatic and juxta-hepatic abscesses by puncture-drainage].

The aim of this study was to show the result obtained by ultrasound-- or CT--guided puncture, possibly associated with transcutaneous drainage, for the treatment of hepatic and perihepatic abscesses. Preoperative imaging guides this treatment. It may reveal cavities as small as 1.5 cm in diameter. This nonsurgical treatment is based on single or multiple punctures, possibly followed by a long percutaneous drainage. The ideal indication is isolate liver abscesses located near the surface, as well as all juxtahepatic suppurative collections. Our experience is based on 73 patients, 32 of them presenting with an intrahepatic abscesses and 41 with a subphrenic or juxtahepatic abscess. For intrahepatic abscesses, healing was obtained with the surgical treatment in 75.3% of all cases: with a single puncture in 5 cases, two or more punctures in 4, and transcutaneous drainage in 11. Out of the 34 cases of perihepatic abscesses that underwent nonsurgical treatment, surgery was avoided in 25 cases, ie. 73.5% of all. Four of them were treated with a single puncture, 3 with repeated puncture, and 18 with transcutaneous drainage. The success of this procedure depends both on the indication and, most importantly, on the accurate application of the procedure.

Adult↗