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PubMed1978

Computed tomography in the diagnosis and management of abdominal abscesses.

Computed tomography (CT) is effective in demonstrating abdominal abscesses and their relation to surrounding structures. The CT signs of abscess are not unlike those demonstrable radiographically and include an abnormal mass, obliteration and displacement of surrounding organs, inappropriate gas, and peripheral enhancement after intravenous contrast. Axial imaging permits selection of safe approaches through which percutaneous needle aspiration can be performed for diagnosis and therapy. When techniques similar to those employed in angiography are used, a catheter can be inserted, the abscess evacuated, and the catheter left in place as a drain. Combined with intravenous antibiotics, this method of abscess drainage has been successful in curing abscesses without surgery. Representative examples are shown.

Abscess↗
PubMed1989

Percutaneous drainage of intra-abdominal abscesses following abdominal trauma.

Between January 1, 1984, and June 30, 1987, we performed percutaneous catheter drainage (PCD) of 28 intra-abdominal abscesses in 21 postoperative trauma patients. During this period only three patients had abdominal re-exploration for drainage of abdominal abscess. The PCD patients were predominantly young men who had sustained penetrating abdominal injuries (81% GSW or SW; 19% MVA). Seventeen (81%) patients had multiple abdominal organ injuries with the colon being the most frequently injured (57%). Multiple abscesses were identified in 33% of the patients. All 21 patients had successful treatment of their abscesses by PCD alone. There was one complication (4.8%) from PCD (pneumothorax) and no deaths in this group. Our data suggest that in most cases, PCD can be safe, effective, and definitive treatment for postoperative intra-abdominal abscesses following abdominal trauma. We recommend PCD in all postoperative trauma patients who develop accessible abdominal abscesses before resorting to re-exploration.

Abdominal Injuries↗
PubMed1981

Diagnosis of postoperative intra-abdominal abscess.

Clinical, laboratory, radiologic, and radionuclide findings of 40 patients with operatively proven intra-abdominal abscesses were evaluated to determine their degree of diagnostic accuracy. Correct preoperative diagnosis was established by clinical, laboratory, and simple radiologic technics in 24 (60%) patients, whereas more sophisticated imaging procedures were used in 16. Gallium citrate Ga 67 scan was done in nine and was positive in six, ultrasonic scan was positive in seven of 16, and computerized tomography in six of eight patients. In 12, two consecutive imaging procedures were used. Concordant results were obtained in eight, of which five were accurate and three inaccurate. Of the four remaining patients with discordant results, the second imaging procedure was incorrect in three and correct in one instance. Accordingly, sophisticated imaging procedures were done in only 40% of patients and were accurate in 75% of less of cases. Furthermore, addition of a second imaging procedure did not increase diagnostic accuracy. Therefore, these technics, while improving the previously existing diagnostic means, should be still considered less than perfect and their negative result should not exclude the need for diagnostic celiotomy when clinical findings are highly suggestive of intra-abdominal abscess.

Abdomen↗
PubMed1992

Percutaneous drainage of 335 consecutive abscesses: results of primary drainage with 1-year follow-up.

Retrospective review of percutaneous abscess drainage (PAD) of 335 abscesses in 323 consecutive patients was undertaken. Particular attention was directed to body location, associated organ system, communications and fistulae, and to the underlying immunologic status of the patient. One-year follow-up was available in all patients. Overall, the cure rate was 62.4% (209 of 335 abscesses), with a failure rate of 8.95% (30 of 335 abscesses). There were 14.2% (46 of 323 patients) deaths in the follow-up period, of which 4.6% (15 of 323 patients) were believed attributable to sepsis or septic complications. The overall complication rate was 9.8% (33 of 335 abscesses), most of which were minor in nature. For the patient exhibiting immunocompromise, representing 53.1% (172 of 323 patients) of the patient population, the cure rate was 53.4% (95 of 178 abscesses), which was significantly lower than the cure rate of 72.6% (114 of 157 abscesses) for the immunocompetent patient population (n = 151) (P less than .001). The recurrence rate was 2.1% (seven of 335 abscesses), with all recurrences within 3 months of initial drainage. PAD is effective and permanent treatment for both immunocompromised and immunocompetent patients.

Abscess↗
PubMed1989

[Tactics in the treatment of subdiaphragmatic abscesses].

The work generalizes an experience with treatment of 42 patients with subdiaphragmatic abscesses. Clinical picture and diagnostic methods are described. The roentgenological examination is thought to play the leading part. All the patients were operated on. Preference is given to the extraperitoneal access after Clairmont followed by drainage of the abscess cavity with a two-lumen tube. Lethality was 21.4%. Prophylactics must be directed to elimination of possible sources of subdiaphragmatic abscesses.

Adult↗