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Intraabdominal abscess after penetrating abdominal trauma.

In 57 (2.4 percent) of 2,416 patients undergoing laparotomy for penetrating abdominal trauma from 1977 to 1980, an intraabdominal abscess developed in the postoperative period. Preoperative antibiotic administration, careful closure of gastrointestinal tract perforation with diversion as necessary, and copious irrigation of the peritoneal cavity at the completion of surgery were common factors in all operations. Over 80 percent of penetrating wounds leading to abscesses occurred in the upper quadrants, and common risk factors included multiple intraabdominal solid organ injuries requiring open drainage, coupled with gastrointestinal tract perforation. Physician delay in the recognition of patients with intraabdominal abscess and in reoperation was a common problem.

Abdominal Injuries↗

Fistuloscopy for the management of postoperative intra-abdominal abscesses.

A new technique of fistuloscopy for evaluation and treatment of postoperative intra-abdominal abscesses is described which was used in 8 patients in whom drainage of abscesses following surgery was insufficient. A cholangiofiberscope was introduced into the fistula canal produced by the postoperative drainage. Fistuloscopy was combined with fistulography in all cases to delineate the extent of the inflammatory process. The guidewire was then placed under visual control through the endoscope followed by re-introduction of the drainage tube until a position most effective for pus drainage was achieved. Following this procedure, fever resolved in all 8 patients. Fistuloscopy is recommended to achieve sufficient drainage of intra-abdominal abscesses in those cases where percutaneous ultrasound- or CT-guided drainage fails to lead to significant clinical improvement.

Abscess↗

Repositioning catheters in surgically drained abscesses.

Primary percutaneous drainage of intraabdominal abscesses under local anesthesia is an accepted method of treatment, with low morbidity and mortality. This technique was extended to patients with recurrent or secondary abscesses after initial primary surgical drainage. Four patients had abscesses drained operatively but were reevaluated several weeks later for recurrent fever. Sinography demonstrated an inadequately drained abscess cavity. Under fluoroscopic control and using local anesthesia, new drains were inserted and repositioned to provide better drainage. Resolution of the abscess cavity was documented radiographically, with improvement in the patients' clinical status.

Abdomen↗

Abdominal abscess drainage under radiologic guidance: causes of failure.

The results of percutaneous drainage of abdominal abscesses in 136 patients are analyzed, revealing a failure rate of 23% (31 patients). The mortality rate was 1.4% (two patients); the rate of serious complications was 5% (seven patients). Failure rate was lowest in critically ill patients having palliative drainage only (12%), emphasizing the importance of immediate drainage to stabilize such patients. The low mortality rate is also attributed to prompt palliative drainage. Technical errors were most commonly responsible for failure of procedures (14%), especially failure to recognize and respond to loculation or subseptation, premature withdrawal of drains (12 patients), and inappropriate approach to the abscess (nine patients). Assignment of patients to a clinical interventional radiology service for the duration of this treatment may greatly facilitate management.

Abdomen↗

[Diagnostic imaging and interventional radiology in abdominal abscess formations].

Abdominal abscesses as a complication of laparotomic surgery have a high mortality rate. The authors reviewed the diagnostic and therapeutic procedures of 36 patients who developed intra-abdominal abscesses after surgical treatment for abdominal neoplasias. The first-step diagnostic procedures (plain film of the abdomen and chest, CT and US) showed a sensibility of 78%. In 25/36 patients (69.5%) two interventional radiology procedures were performed: fine needle aspiration and catheter drainage of the abscess. In 16% of patients fine needle aspiration led to a complete evacuation of the abscess cavity and guaranteed the recovery. In 84% of cases a drainage catheter was positioned into the cavity and left indwelling. This case review is aimed at stressing how plain film of the abdomen is still a diagnostic procedure with high sensibility and specificity for this pathology, even though it is currently considered as a second-choice diagnostic step--US and CT being assessed as the methodologies of choice. The latter techniques can both provide a more accurate imaging when interventional radiology procedures are to be performed.

Abdomen↗

[Giant abdominal abscesses--a hitherto unrecognized disease].

Two cases of giant intraabdominal supra-colic abscess are described. Since the clinical symptoms are often unimpressive and nonspecific, there was a delay in diagnosis. The causes were unrecognized perforated peptic ulcers in both patients. Pathophysiology, incidence and possible localizations of intraabdominal abscesses are discussed. A review of intraabdominal anatomy is important for an understanding of the peritoneal spaces in which abscesses can occur.

Abscess↗