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Stahl R, Seidensticker M, Arbogast H, Kuppinger D, Greif V, Crispin A, D’Anastasi M, Pedersen V, Forbrig R, Liebig T, Rutetzki T, Trumm CG. Technical and Clinical Outcome of Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement in Abdominal Fluid Collections after Liver Transplantation: A 16-Year Retrospective Analysis of 50 Consecutive Patients. Diagnostics (Basel) 2024; 14:353. [PMID: 38396392 PMCID: PMC10887879 DOI: 10.3390/diagnostics14040353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE Evaluation of the effectiveness of CT-guided drainage (CTD) placement in managing symptomatic postoperative fluid collections in liver transplant patients. The assessment included technical success, clinical outcomes, and the occurrence of complications during the peri-interventional period. METHODS Analysis spanned the years 2005 to 2020 and involved 91 drain placement sessions in 50 patients using percutaneous transabdominal or transhepatic access. Criteria for technical success (TS) included (a) achieving adequate drainage of the fluid collection and (b) the absence of peri-interventional complications necessitating minor or prolonged hospitalization. Clinical success (CS) was characterized by (a) a reduction or normalization of inflammatory blood parameters within 30 days after CTD placement and (b) the absence of a need for surgical revision within 60 days after the intervention. Inflammatory markers in terms of C-reactive protein (CRP), leukocyte count and interleukin-6, were evaluated. The dose length product (DLP) for various intervention steps was calculated. RESULTS The TS rate was 93.4%. CS rates were 64.3% for CRP, 77.8% for leukocytes, and 54.5% for interleukin-6. Median time until successful decrease was 5.0 days for CRP and 3.0 days for leukocytes and interleukin-6. Surgical revision was not necessary in 94.0% of the cases. During the second half of the observation period, there was a trend (p = 0.328) towards a lower DLP for the entire intervention procedure (median: years 2013 to 2020: 623.0 mGy·cm vs. years 2005 to 2012: 811.5 mGy·cm). DLP for the CT fluoroscopy component was significantly (p = 0.001) lower in the later period (median: years 2013 to 2020: 31.0 mGy·cm vs. years 2005 to 2012: 80.5 mGy·cm). CONCLUSIONS The TS rate of CT-guided drainage (CTD) placement was notably high. The CS rate ranged from fair to good. The reduction in radiation exposure over time can be attributed to advancements in CT technology and the growing expertise of interventional radiologists.
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Affiliation(s)
- Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Max Seidensticker
- Department of Radiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.S.); (V.G.)
| | - Helmut Arbogast
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (H.A.); (D.K.)
| | - David Kuppinger
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (H.A.); (D.K.)
| | - Veronika Greif
- Department of Radiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.S.); (V.G.)
| | - Alexander Crispin
- IBE—Institute for Medical Information Processing, Biometry and Epidemiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Melvin D’Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, MSD 2090 Msida, Malta;
| | - Vera Pedersen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Robert Forbrig
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Thomas Liebig
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Tim Rutetzki
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Christoph G. Trumm
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
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Berenson A, Doran M, Strollo B, Burton J, Townsend M, Babin J, Millien J, Brown R, Fuhrman G. An Analysis of Outcomes and Management Strategies for Patients With Cholecystostomy Tubes. Am Surg 2023; 89:4424-4430. [PMID: 35852865 DOI: 10.1177/00031348221109459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Percutaneous cholecystostomy tube (PCT) drainage is an effective management strategy for acute cholecystitis in patients medically unfit for surgery. However, little is known about the fate of patients managed by PCT. We conducted this study to determine tube management outcomes for patients with acute cholecystitis managed by PCT. METHODS The electronic record was queried to identify patients with acute cholecystitis managed by PCT from 2012-2020. Patients were divided into three groups for analysis: 1) ultimately managed by cholecystectomy, 2) eventual confirmation of distal flow of bile from the gallbladder and tube removal, and 3) tubes left in place without further management. RESULTS A total of 179 patients with acute cholecystitis treated by PCT were included. Sixty-six patients never fully recovered from the medical insult associated with their diagnosis of acute cholecystitis and had their tubes left in situ. Sixty-four of these 66 patients (97%) died during follow-up. The remaining 113 patients recovered from their illness and presented to clinic for evaluation for tube removal and/or cholecystectomy. When distal biliary flow was confirmed, tube removal was favored (n = 70). When cystic duct outflow occlusion persisted, cholecystectomy was planned for patients who became acceptable surgical candidates (n = 43). For patients managed by cholecystectomy, 8 were approached open and 35 laparoscopically, with 12 of 35 (34.3%) converted to open and 23 (65.7%) completed laparoscopically. CONCLUSION Our study favors PCT removal for patients who recover from their acute illness when distal bile flow from the gallbladder is confirmed. We reserve cholecystectomy for patients who recover from their illness and demonstrate persistent cystic duct outflow obstruction.
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Affiliation(s)
- Adam Berenson
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Marisa Doran
- Ochsner Clinical School,The University of Queensland Faculty of Medicine, New Orleans, LA, USA
| | - Brian Strollo
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
- Ochsner Clinical School,The University of Queensland Faculty of Medicine, New Orleans, LA, USA
| | - Jeff Burton
- Ochsner Health Center for Outcomes and Health Services Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Michael Townsend
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Jonathan Babin
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Jeffanne Millien
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
- Ochsner Clinical School,The University of Queensland Faculty of Medicine, New Orleans, LA, USA
| | - Russell Brown
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - George Fuhrman
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
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Nozawa Y, Masuda K, Arahata K, Kobashi Y, Ikeda K, Suzuki T. Percutaneous trans-bladder drainage of a pelvic abscess caused by sigmoid diverticulitis: Two case reports. Radiol Case Rep 2023; 18:3675-3679. [PMID: 37601118 PMCID: PMC10432259 DOI: 10.1016/j.radcr.2023.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/19/2023] [Accepted: 07/23/2023] [Indexed: 08/22/2023] Open
Abstract
Sigmoid diverticulitis can potentially lead to the development of pelvic abscesses. Mortality rate from intra-abdominal abscesses is as high as 35%, and patients with diverticulitis complicated by an abscess are at a high risk of recurrent diverticulitis. Recently, image-guided drainage has been performed using computed tomography or ultrasonography for the treatment of pelvic abscesses. Standard radiological pelvic abscess image-guided drainage methods consist of transabdominal, transgluteal, or cranio-caudal puncture approaches. However, these standard approaches have technical limitations due to intrapelvic organ structures. Therefore, we performed image-guided drainage using a percutaneous trans-bladder approach with a simpler 1-step puncture method and a less invasive 7-Fr drainage catheter in 2 cases of a 72-year-old female and a 53-year-old female with relapsed pelvic abscesses complicated by sigmoid diverticulitis due to difficulties involving the standard approach. The abscesses in both cases disappeared on follow-up computed tomography scans, demonstrating no pelvic abscess recurrence. Our results showed that trans-bladder image-guided drainage is an effective alternative method for treating pelvic abscesses.
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Affiliation(s)
- Yosuke Nozawa
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba 272-8513, Japan
| | - Koichi Masuda
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba 272-8513, Japan
| | - Kyoko Arahata
- Department of Gastroenterology, Tokyo Dental College Ichikawa General Hospital, Ichikawa-shi, Chiba, Japan
| | - Yuko Kobashi
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba 272-8513, Japan
| | - Koshi Ikeda
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba 272-8513, Japan
| | - Taiga Suzuki
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba 272-8513, Japan
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Tanikawa T, Kawada M, Ishii K, Urata N, Nishino K, Suehiro M, Kawanaka M, Haruma K, Kawamoto H. Efficacy of endoscopic ultrasound-guided abscess drainage for non-pancreatic abscesses: A retrospective study. JGH Open 2023; 7:470-475. [PMID: 37496811 PMCID: PMC10366484 DOI: 10.1002/jgh3.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023]
Abstract
Background and Aim Percutaneous drainage of intra-abdominal abscesses is often uncomfortable for the patient and may result in prolonged hospital stays. Recent studies have shown that endoscopic ultrasound-guided abscess drainage (EUS-AD) could effectively treat various abscesses and fluid collections. However, no indications or procedures have been established for EUS-AD treatments, and studies on its usefulness and safety are insufficient. The present study aimed to evaluate the efficacy and safety of EUS-AD for treating non-pancreatic abscesses. Methods This retrospective study included 20 patients, aged ≥20 years, who underwent EUS-AD for an abscess or fluid accumulation in the abdomen or mediastinum, but not the pancreas. Patients were treated at the Kawasaki University General Medical Center between March 2013 and June 2021. All EUS-AD procedures were performed prior to a percutaneous drainage or surgical drainage. Results Among the 20 patients who underwent an EUS-AD for abscess, 8 (40%) had liver abscesses, 6 (30%) had intraperitoneal abscesses, 3 had (15%) splenic abscesses, 1 (5%) had a mediastinal abscess, 1 (5%) had an iliopsoas abscess (n = 1, 5%), and 1 (5%) had an abdominal wall abscess. The technical success rate was 95% (n = 19/20). We inserted nasobiliary catheters in 4/20 patients (20%). The clinical success rate was 90% (n = 18/20). Two clinical failures required reintervention, and both were treated with percutaneous drainage. Adverse events were observed in 2/20 patients (10%). One patient experienced fever after the procedure, and the other experienced localized peritonitis. Conclusion EUS-AD was effective and safe for abscess removal, particularly when approached from the upper gastrointestinal tract.
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Affiliation(s)
- Tomohiro Tanikawa
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Mayuko Kawada
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Katsunori Ishii
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Noriyo Urata
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Ken Nishino
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Miwa Kawanaka
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Ken Haruma
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
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Peeters H, Simoens M, Lenz J. EUS-guided transrectal drainage of pelvic abscesses: a retrospective analysis of 17 patients. Acta Gastroenterol Belg 2023; 86:395-400. [PMID: 37814555 DOI: 10.51821/86.3.12029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Background Pelvic abscess is a common complication of abdominal surgery or intestinal or gynecological diseases. Over the last decades, endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to percutaneous or surgical treatment of pelvic abscesses. Aim To evaluate safety and efficacy of EUS-guided transrectal pelvic abscess drainage in a single center. Methods From February 2017 to April 2023, all data on patients who were treated for pelvic abscesses by EUS-guided drainage in a single center, were retrospectively analyzed. Results A total of 17 patients were treated for pelvic abscesses by EUS-guided drainage. The procedure was technically successful and uneventful in all 17 patients (100%). Etiology of the abscess was postsurgical (n=5, 29%), secondary to medical illness (n=10, 59%) or gastrointestinal perforation (n=2, 12%). The abscess was multilocular in 5 patients (29%), the mean largest diameter was 76 mm (range 40-146 mm). Drainage was performed using 2 double pigtail stents, and in 1 patient an additional 10 Fr drainage catheter was deployed. Two patients (12%) required a second endoscopic intervention. Treatment success, defined by complete abscess resolution on follow-up CT scan along with symptom relief, was 100%. There was no need for surgical intervention. The median post-procedural hospital stay was 5 days. No recurrence was reported within a median time of follow-up of 39 months. Conclusion EUS-guided transrectal drainage of pelvic abscesses using double pigtail stents is safe and highly effective. This case series contributes to the cumulative evidence that, in expert hands, EUS-guided drainage should be considered as first-line approach for treatment of pelvic abscesses.
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Affiliation(s)
- H Peeters
- Department of Gastroenterology, University Hospitals Leuven, Belgium
| | - M Simoens
- Department of Gastroenterology, ZNA Jan Palfijn, Belgium
| | - J Lenz
- Department of Gastroenterology, ZNA Jan Palfijn, Belgium
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Stahl R, Seidensticker M, de Figueiredo GN, Pedersen V, Crispin A, Forbrig R, Ozpeynirci Y, Liebig T, D’Anastasi M, Hackner D, Trumm CG. Low-Dose CT Fluoroscopy-Guided Drainage of Deep Pelvic Fluid Collections after Colorectal Cancer Surgery: Technical Success, Clinical Outcome and Safety in 40 Patients. Diagnostics (Basel) 2023; 13:diagnostics13040711. [PMID: 36832199 PMCID: PMC9955776 DOI: 10.3390/diagnostics13040711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To assess the technical (TS) and clinical success (CS) of CT fluoroscopy-guided drainage (CTD) in patients with symptomatic deep pelvic fluid collections following colorectal surgery. METHODS A retrospective analysis (years 2005 to 2020) comprised 43 drain placements in 40 patients undergoing low-dose (10-20 mA tube current) quick-check CTD using a percutaneous transgluteal (n = 39) or transperineal (n = 1) access. TS was defined as sufficient drainage of the fluid collection by ≥50% and the absence of complications according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). CS comprised the marked reduction of elevated laboratory inflammation parameters by ≥50% under minimally invasive combination therapy (i.v. broad-spectrum antibiotics, drainage) within 30 days after intervention and no surgical revision related to the intervention required. RESULTS TS was gained in 93.0%. CS was obtained in 83.3% for C-reactive Protein and in 78.6% for Leukocytes. In five patients (12.5%), a reoperation due to an unfavorable clinical outcome was necessary. Total dose length product (DLP) tended to be lower in the second half of the observation period (median: years 2013 to 2020: 544.0 mGy*cm vs. years 2005 to 2012: 735.5 mGy*cm) and was significantly lower for the CT fluoroscopy part (median: years 2013 to 2020: 47.0 mGy*cm vs. years 2005 to 2012: 85.0 mGy*cm). CONCLUSIONS Given a minor proportion of patients requiring surgical revision due to anastomotic leakage, the CTD of deep pelvic fluid collections is safe and provides an excellent technical and clinical outcome. The reduction of radiation exposition over time can be achieved by both the ongoing development of CT technology and the increased level of interventional radiology (IR) expertise.
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Affiliation(s)
- Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
- Correspondence: ; Tel.: +49-89-4400-74629
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Giovanna Negrão de Figueiredo
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstr. 10, 8091 Zurich, Switzerland
| | - Vera Pedersen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Alexander Crispin
- IBE—Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Forbrig
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Yigit Ozpeynirci
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Thomas Liebig
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Melvin D’Anastasi
- Department of Radiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
- Medical Imaging Department, Mater Dei Hospital, University of Malta, MSD 2090 Msida, Malta
| | - Danilo Hackner
- Department of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Christoph G. Trumm
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
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Pu X, Huang S, Zhang L, Zhang H, Xia H, Zeng X, Lü M, Peng Y, Ren J, Tang X. Endoscopic ultrasound-guided drainage of pelvic abscess: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2022; 16:993-1002. [PMID: 36170047 DOI: 10.1080/17474124.2022.2130247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES As an emerging minimally invasive technology, endoscopic ultrasound (EUS) has been reported to treat pelvic abscess instead of surgical or image-guided percutaneous drainage (PCD) under certain conditions. The aim of this study was to assess the efficacy and safety of EUS-guided drainage for patients with pelvic abscesses. METHODS We conducted a comprehensive literature search on PubMed, Embase, Cochrane Library, and Web of Science databases (inception-March 2022). The main outcomes were technical success, clinical success, and complications. Comprehensive meta-analysis software was used to calculate the pooled event rate. RESULTS Twelve studies containing 272 patients were included. These pelvic abscesses most frequently developed after abdominal and pelvic surgery (n = 180, 66.2%), inflammatory bowel disease (n = 32, 11.8%), and other inflammatory conditions. Respectively, the pooled technical and clinical success rate was 100% and 88.7% [95% confidence interval (CI): 83.8-92.2%, I2 = 1.0%, p < 0.001]. After excluding an individual study, the pooled rate of complications changed from 11.5% (95% CI: 7.4-17.4%, I2 = 38.8%, p < 0.001) to 8.2% (95% CI: 5.0-13.3%, I2 = 0, p < 0.001). CONCLUSIONS EUS-guided drainage of the pelvic abscess was feasible, effective, and safe. Further randomized-controlled studies with large-sample sizes were required in the future.
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Affiliation(s)
- Xinxin Pu
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Shu Huang
- Department of Gastroenterology, the People's Hospital of Lianshui, Huaian, Jiangsu province, China
| | - Lu Zhang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Han Zhang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Huifang Xia
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Xinyi Zeng
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Muhan Lü
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yan Peng
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Jing Ren
- Department of Nursing, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Department of Endoscopic Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Xiaowei Tang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
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Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement after Pancreatic Surgery: Technical and Clinical Outcome in 133 Consecutive Patients during a 14-Year Period. Diagnostics (Basel) 2022; 12:diagnostics12092243. [PMID: 36140644 PMCID: PMC9498101 DOI: 10.3390/diagnostics12092243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Purpose: To retrospectively assess the technical and clinical outcome of patients with symptomatic postoperative fluid collections after pancreatic surgery, treated with CT-guided drainage (CTD). (2) Methods: 133 eligible patients between 2004 and 2017 were included. We defined technical success as the sufficient drainage of the fluid collection(s) and the absence of peri-interventional complications (minor or major according to SIR criteria). Per definition, clinical success was characterized by normalization of specific blood parameters within 30 days after the intervention or a decrease by at least 50% without requiring additional surgical revision. C-reactive protein (CRP), Leukocytes, Interleukin-6, and Dose length product (DLP) for parts of the intervention were determined. (3) Results: 97.0% of 167 interventions were technically successful. Clinical success was achieved in 87.5% of CRP, in 78.4% of Leukocytes, and in 87.5% of Interleukin-6 assessments. The median of successful decrease was 6 days for CRP, 5 days for Leukocytes, and 2 days for Interleukin-6. No surgical revision was necessary in 93.2%. DLP was significantly lower in the second half of the observation period (total DLP: median 621.5 mGy*cm between 2011–2017 vs. median 944.5 mGy*cm between 2004–2010). (4) Conclusions: Technical success rate of CTD was very high and the clinical success rate was fair to good. Given an elderly and multimorbid patient cohort, CTD can have a temporizing effect in the postoperative period after pancreatic surgery. Reducing the radiation dose over time might reflect developments in CT technology and increased experience of interventional radiologists.
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Sari MA, Camacho A, Ahmed M, Siewert B, Brook I, Brook OR. Is routine imaging necessary prior to percutaneous abscess catheter removal? ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2604-2611. [PMID: 35286421 DOI: 10.1007/s00261-022-03460-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Routine management after abscess drainage includes CT or fluoroscopic imaging to assess for residual abscess cavity prior to catheter removal. It is unclear whether this practice is necessary in patients without residual infection signs and symptoms. PURPOSE To evaluate safety of abscess catheter removal without follow-up imaging in patients without residual clinical or laboratory signs of infection and catheter output < 10 cc/day for 2 consecutive days. MATERIALS AND METHODS In this IRB-approved, HIPAA compliant, retrospective study, consecutive patients that underwent percutaneous CT-guided drainage of a single abdominal or pelvic abscess between 01/2015 and 12/2017 in a single tertiary academic institution with or without follow-up imaging prior to catheter removal were included. In our institution, catheters are routinely removed without imaging if there are no clinical (fever, pain) or laboratory (elevated WBC count) signs of infection and catheter output is < 10 cc/day for 2 consecutive days. Patients' and abscess's characteristics, repeat imaging data, and need for re-interventions were obtained through medical records review. Statistical analysis was performed with Fisher's exact test for independent data and Student's t-test for comparison of group means. RESULTS 310 consecutive patients (age 56 ± 16 years, 48% female) were included in the study. In 265/310 (85%) patients, no routine follow-up imaging prior to catheter removal was obtained. In 2/265 (0.8%, 95% CI 0.02-0.27%) patients without routine pre-removal imaging, repeat abscess drainage was required 6 and 15 days after catheter removal in patient with perforated appendicitis and after laparoscopic renal cyst decortication, respectively. No patients, 0/45 (0%, 95% CI 0-0.07), that underwent routine imaging without clinical or laboratory signs infection needed to undergo a repeat abscess drainage. CONCLUSION There is a low rate (0.8%) of abscess recurrence if percutaneous abscess catheter is removed at the time cessation of drainage without routine imaging in clinically well patient.
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Affiliation(s)
- Mehmet A Sari
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Andrés Camacho
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Iris Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
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Kucharzik T, Tielbeek J, Carter D, Taylor SA, Tolan D, Wilkens R, Bryant RV, Hoeffel C, De Kock I, Maaser C, Maconi G, Novak K, Rafaelsen SR, Scharitzer M, Spinelli A, Rimola J. ECCO-ESGAR Topical Review on Optimizing Reporting for Cross-Sectional Imaging in Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:523-543. [PMID: 34628504 DOI: 10.1093/ecco-jcc/jjab180] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The diagnosis and follow up of patients with inflammatory bowel disease [IBD] requires cross-sectional imaging modalities, such as intestinal ultrasound [IUS], magnetic resonance imaging [MRI] and computed tomography [CT]. The quality and homogeneity of medical reporting are crucial to ensure effective communication between specialists and to improve patient care. The current topical review addresses optimized reporting requirements for cross-sectional imaging in IBD. METHODS An expert consensus panel consisting of gastroenterologists, radiologists and surgeons convened by the ECCO in collaboration with ESGAR performed a systematic literature review covering the reporting aspects of MRI, CT, IUS, endoanal ultrasonography and transperineal ultrasonography in IBD. Practice position statements were developed utilizing a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when ≥80% of the participants agreed on a recommendation. RESULTS Twenty-five practice positions were developed, establishing standard terminology for optimal reporting in cross-sectional imaging. Assessment of inflammation, complications and imaging of perianal CD are outlined. The minimum requirements of a standardized report, including a list of essential reporting items, have been defined. CONCLUSIONS This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD.
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Affiliation(s)
- Torsten Kucharzik
- Department of Gastroenterology, Klinikum Lüneburg, University of Hamburg, Bögelstr. 1, 21339 Lüneburg, Germany
| | - Jeroen Tielbeek
- Department of Radiology, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hasomher, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Damian Tolan
- Radiology Department, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK
| | - Rune Wilkens
- Gastrounit, Division of Medicine, Hvidovre University Hospital, Copenhagen, Denmark; Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Copenhagen, Denmark
| | - Robert V Bryant
- Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia
| | - Christine Hoeffel
- Department of Abdominal Radiology, CHU Reims and CRESTIC, URCA, 51100 Reims, France
| | - Isabelle De Kock
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Christian Maaser
- Outpatient Department of Gastroenterology, Department of Geriatrics, Klinikum Lüneburg, University of Hamburg, Bögelstr. 1, 21339 Lüneburg, Germany
| | - Giovanni Maconi
- Gastroenterology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Kerri Novak
- Department of Radiology and Medicine, Division of Gastroenterology, University of Calgary, Alberta, Canada
| | - Søren R Rafaelsen
- Department of Radiology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Jordi Rimola
- IBD unit, Radiology Department, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
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11
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CT-guided percutaneous drainage of abdominopelvic collections: a pictorial essay. Radiol Med 2021; 126:1561-1570. [PMID: 34415507 PMCID: PMC8702416 DOI: 10.1007/s11547-021-01406-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/28/2021] [Indexed: 11/06/2022]
Abstract
CT-guided percutaneous drainage is a safe and effective procedure that allows minimally invasive treatment of abdominopelvic abscesses and fluid collections. This technique has become an alternative for surgery with lower morbility and mortality rates. In this pictorial essay, we aim at providing an overview of the technical approaches, the main clinical indications and complications of CT-guided percutaneous drainage, in order to provide a practical guide for interventional radiologists, with a review of the recent literature. The focus will be the CT-guidance, preferred when the interposition of viscera, vascular and skeletal structures, counteracts the ultrasound guidance.
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12
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[Unusual cause of unclear abdominal complaints]. Chirurg 2021; 92:955-958. [PMID: 34100983 DOI: 10.1007/s00104-021-01405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
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13
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CT-Guided Drainage of Fluid Collections Following Liver Resection: Technical and Clinical Outcome of 143 Patients during a 14-Year Period. Diagnostics (Basel) 2021; 11:diagnostics11050826. [PMID: 34063329 PMCID: PMC8147601 DOI: 10.3390/diagnostics11050826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose: To retrospectively evaluate the technical and clinical outcome of patients with symptomatic postoperative fluid collections following liver resection treated with CT-guided drainage (CTD). Methods: 143 suitable patients were examined between 2004 and 2017. Technical success was defined as (a) sufficient drainage of the fluid collection and (b) the non-occurrence of peri-interventional complications requiring surgical treatment with minor or prolonged hospitalization. Clinical success was defined as (a) decreasing or normalization of specific blood parameters within 30 days after intervention and (b) no surgical revision in addition to intervention required. C-reactive protein (CRP), leukocytes and Total Serum Bilirubin (TSB) were assessed. Dose length product (DLP) for the intervention parts was determined. Results: Technical success was achieved in 99.5% of 189 performed interventions. Clinical success was reached in 74% for CRP, in 86.7% for Leukocytes and in 62.1% for TSB. The median of successful decrease was 6.0 days for CRP, 3.5 days for Leukocytes and 5.5 days for TSB. In 90.2%, no surgical revision was necessary. Total DLP was significantly lower in the second half of the observation period (median 536.0 mGy*cm between years 2011 and 2017 vs. median 745.5 mGy*cm between years 2004 and 2010). Conclusions: Technical success rate of CTD was very high, and clinical success rate was fair to good. Reduction of the radiation dose reflects developments of CT technology and increased experience of the interventional radiologists.
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14
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Dhindsa BS, Naga Y, Saghir SM, Dhaliwal A, Ramai D, Cross C, Singh S, Bhat I, Adler DG. EUS-guided pelvic drainage: A systematic review and meta-analysis. Endosc Ultrasound 2021; 10:185-190. [PMID: 33463556 PMCID: PMC8248303 DOI: 10.4103/eus.eus_71_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: EUS-guided pelvic abscess drainage (EUS-PAD) is a procedure that utilizes an echoendoscope to visualize an area of interest for needle insertion and placement of a stent, catheter, or both for drainage of the target abscess. The aim of this study was to perform a systematic review and meta-analysis for the safety and efficacy of EUS-PAD. Materials and Methods: We conducted a comprehensive search of several databases and conference proceedings including PubMed, EMBASE, Google Scholar, MEDLINE, SCOPUS, and Web of Science databases (earliest inception to February 2020). The primary outcomes for this study were the technical and clinical success of EUS-PAD. The secondary outcomes assessed for this study were adverse events of the procedure and subgroup analysis of individual adverse events. Results: Eight studies with a total of 135 patients combined were included in our analysis. The rate of technical success was 100% and the calculated pooled rate of clinical success was 92% (95% confidence interval [CI]: 87%, 98%; P = 0.31; I2 = 15%). The calculated pooled rate of adverse events was 9.4% (±17.9%), with stent migration (5.5 ± 18.06%) being the most common adverse event. Conclusion: EUS-PAD offers a viable alternative that can minimize the need for surgical intervention in the drainage of pelvic abscesses. EUS-PAD has also demonstrated long-term clinical success with an acceptable rate of complications.
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Affiliation(s)
- Banreet Singh Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, USA
| | - Yassin Naga
- Department of Internal Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Syed Mohsin Saghir
- Department of Internal Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, Moffitt Cancer Center, Tampa, FL, USA
| | - Daryl Ramai
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Chad Cross
- Department of Biostatistics and Epidemiology, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, USA
| | - Ishfaq Bhat
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, USA
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah, School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah, USA
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15
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Paired Drainage Catheter Insertion: Feasibility of Placing Two Catheters within the Same Complex Abscess Cavity as a Primary and Salvage Percutaneous Drainage Technique. Acad Radiol 2020; 27:e1-e9. [PMID: 31031185 DOI: 10.1016/j.acra.2019.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/21/2019] [Accepted: 03/04/2019] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the feasibility of paired catheter drainage for management of complex abdominal abscesses. MATERIALS AND METHODS This was a single-center retrospective study of 54 patients (35 males; mean age 48.9 years) that underwent paired catheter insertion for complex abdominal fluid collections in an 18-month period. Complex collections were defined as abscesses ≥6 cm in diameter with septations, high viscosity fluid or necrotic debris, or abscesses with an associated fistula. Abscess etiologies included postoperative (n = 28), pancreatitis (n = 12), perforated bowel (n = 7), liver abscess (n = 4), and perihepatic from gallbladder perforation (n = 3). Paired catheter insertion was defined two catheters co-located within one collection through the same skin incision or two closely spaced insertion sites. Paired catheter insertion was used primarily as initial drainage for complex intraabdominal abscesses and for salvage drainage in collections that could not be evacuated by a single catheter. Primary paired catheter insertion was used in 45 patients and as salvage in nine patients. RESULTS Abscess resolution occurred in 51 (94.4%) patients. Patients had a median of three drainage procedures. Median duration of paired catheterization was 22 days. Seven abscesses recurred and all resolved with repeated drainage. Complications included one hemorrhage that was taken for surgical exploration. Overall, 48 patients had good clinical outcome, 3 patients died (multiorgan failure, n = 2; sepsis, n = 1), and 3 patients were lost to follow-up. CONCLUSION Percutaneous paired catheter drainage is a feasible technique for the treatment of both complex intraabdominal abscesses and abscesses unresponsive to single catheter drainage.
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16
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Mubarak WM, Sheikh N, John P, Temple MJ, Amaral JG, Connolly BL. Use of the Transrectal Ultrasound Probe in Aspiration and Drainage in Pediatric Patients: A Retrospective Observational Study. J Vasc Interv Radiol 2019; 30:908-914. [PMID: 30956079 DOI: 10.1016/j.jvir.2018.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 09/12/2018] [Accepted: 09/15/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To retrospectively evaluate the safety and efficacy of transrectal ultrasound (TRUS) probe use for aspiration and drainage of pelvic abscesses in children. MATERIALS AND METHODS Patient demographics, procedural details, technical success, safety, and clinical course of TRUS procedures were retrospectively analyzed. Between 2007 and 2016, 118 TRUS-guided procedures were performed in 115 children (60 males, 55 females); median age was 12.4 years (range, 2.4-17.9 years) and median weight was 45 kg (range, 12.6-112 kg). Ten children were 5 years of age or younger. RESULTS In total, 113/118 procedures were performed under general anesthesia. The rectum accommodated the probe and needle guide without resistance in all children (technical feasibility, 100%). Abscesses were anterior to the rectum in 116/118 and posterior in 2/118. One hundred twelve collections were drained, 4 were aspirated, and 2 procedures were aborted, both subsequently successfully drained (2 and 3 days later). One patient underwent repeat drainage after 28 months. No major complications were reported. Median times to temperature normalization was 0 days (mean, 1.2; range, 0-13 days), catheter dwell time 5 days (mean, 6; range, 2-21 days), drain removal to discharge 1 day (mean, 2; range, 0-41 days), and follow-up 117 days (mean, 195; range, 5-2,690 days). CONCLUSIONS TRUS-guided drainage using the TRUS probe and needle guide is a safe and effective method for aspiration and drainage of pelvic abscesses in children as young as 2 years.
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Affiliation(s)
- Walid Mabrouk Mubarak
- Division of Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, 2810B, Toronto, Canada M5G 1X8.
| | - Natasha Sheikh
- Division of Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, 2810B, Toronto, Canada M5G 1X8
| | - Philip John
- Division of Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, 2810B, Toronto, Canada M5G 1X8
| | - Michael J Temple
- Division of Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, 2810B, Toronto, Canada M5G 1X8
| | - Joao G Amaral
- Division of Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, 2810B, Toronto, Canada M5G 1X8
| | - Bairbre L Connolly
- Division of Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, 2810B, Toronto, Canada M5G 1X8
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Damar Ç, Özdemir M, Hekimoğlu B. İntraabdominal Apselerin Görüntüleme Eşliğinde Perkütan Drenajı. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.534834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Natural history of percutaneous drainage of postoperative collection following colorectal surgery: in which patients can follow-up imaging be dispensed with before drain removal? Abdom Radiol (NY) 2019; 44:1135-1140. [PMID: 30382300 DOI: 10.1007/s00261-018-1811-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Colorectal surgery is complicated by postoperative collections in up to 25% of cases depending on local conditions. The aim of this study was to identify predictive factors of success of percutaneous drainage of collections in order to avoid follow-up imaging. PATIENTS AND METHODS All consecutive patients between January 2009 and December 2016, who had undergone elective or emergency colorectal surgery (colorectal surgery and appendectomy) complicated by a postoperative collection treated by percutaneous drainage with follow-up imaging prior to drain removal, were included in this single-center and retrospective study. The primary objective was to assess predictive factors of success of the first attempt of percutaneous drainage of collections. Secondary objectives were to describe the natural history of percutaneous drainage of postoperative collections after colorectal surgery and the overall success rate of percutaneous drainage. RESULTS Fifty-three patients underwent percutaneous drainage of a postoperative collection during the study period and were included in this study. Complete resolution of the collection was observed on the first follow-up radiological examination in 36 patients (58%). In multivariate analysis, post-appendectomy collections (OR = 3.19 (1.14-9.27), p = 0.002) and reduction of the leukocyte count (OR = 3.22 (1.28-8.1), p = 0.013) were significantly associated with success of percutaneous drainage. CONCLUSION This is the first study to address that follow-up imaging prior to drain removal might not be necessary in patients undergoing drainage of post-appendectomy collections and/or with more than 30% reduction of the leukocyte count at the first follow-up examination.
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Akıncı D, Ergun O, Topel Ç, Çiftçi T, Akhan O. Pelvic abscess drainage: outcome with factors affecting the clinical success. ACTA ACUST UNITED AC 2018; 24:146-152. [PMID: 29770767 DOI: 10.5152/dir.2018.16500] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE We aimed to evaluate the success and complication rates of image-guided pelvic abscess drainage with emphasis on factors affecting the clinical success. METHODS During a 7-year period, 185 pelvic abscesses were treated in 163 patients under ultrasonography and fluoroscopy (n=140) or computed tomography (n=45) guidance with transabdominal (n=107), transvaginal (n=39), transrectal (n=21) and transgluteal (n=18) approaches. Abscess characteristics (etiology, number, size, intrastructure, microbiological content, presence of fistula), patient demographics (age, sex, presence of malignancy, primary disease, antibiotic treatments), procedure-related factors (guidance method, access route, catheter size) and their effects on clinical success, complications, and duration of catheterization were statistically analyzed. RESULTS Technical and clinical success rates were 100% and 93.9%, respectively. Procedure-related mortality or major complications were not observed. Minor complications such as catheter dislodgement, obstruction, or kinking were detected in 6.7% of the patients. Clinical failure was observed in 10 patients (6.1%). Fistulization was observed in 14 abscesses. Fistulization extended the duration of catheter use (P < 0.001) and decreased the clinical success rate (P < 0.001). The presence of postoperative malignant, complex-multilocular abscesses, and fungus infection in the cavity extended catheter duration (P < 0.001, P = 0.018, and P = 0.007, respectively), whereas the presence of sterile abscess and endocavitary catheterization reduced the catheter duration (P = 0.009 and P = 0.011, respectively). CONCLUSION Image-guided pelvic abscess drainage has high clinical success and low complication rates. The only factor affecting the clinical success rate is the presence of fistula.
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Affiliation(s)
- Devrim Akıncı
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Onur Ergun
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Çağdaş Topel
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Türkmen Çiftçi
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Kajiwara K, Yamagami T, Ishikawa M, Yoshimatsu R, Baba Y, Nakamura Y, Fukumoto W, Awai K. CT fluoroscopy-guided percutaneous drainage: comparison of the one step and the Seldinger techniques. MINIM INVASIV THER 2016; 26:162-167. [DOI: 10.1080/13645706.2016.1261901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kenji Kajiwara
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Takuji Yamagami
- Department of Radiology, Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Masaki Ishikawa
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Fukumoto
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Mauri G, Pescatori LC, Mattiuz C, Poretti D, Pedicini V, Melchiorre F, Rossi U, Solbiati L, Sconfienza LM. Non-healing post-surgical fistulae: treatment with image-guided percutaneous injection of cyanoacrylic glue. Radiol Med 2016; 122:88-94. [PMID: 27752970 DOI: 10.1007/s11547-016-0693-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/03/2016] [Indexed: 02/06/2023]
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Narasimhulu DM, Shi S. Delayed presentation of uterine rupture postpartum. Am J Obstet Gynecol 2015; 212:680.e1-2. [PMID: 25584787 DOI: 10.1016/j.ajog.2015.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/29/2014] [Accepted: 01/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Deepa M Narasimhulu
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY.
| | - Susan Shi
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY
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23
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Holtz A, Plebani A, Talsky N, Itin H, Letta C. [A rare differential diagnosis of acute appendicitis]. Chirurg 2015; 86:797-9. [PMID: 25636637 DOI: 10.1007/s00104-014-2953-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A Holtz
- Kantonsspital St. Gallen, Standort Flawil, Krankenhausstr. 23, 9230, Flawil, St. Gallen, Schweiz
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Endoscopic ultrasound-guided pelvic and prostatic abscess drainage: experience in 30 patients. Indian J Gastroenterol 2014; 33:410-3. [PMID: 25015744 DOI: 10.1007/s12664-014-0485-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/25/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided drainage is an effective treatment for many abscesses in the abdomen. We review our experience with EUS-guided drainage of pelvic abscesses. METHODS Thirty consecutive patients who underwent EUS-guided pelvic abscess drainage were evaluated after excluding three patients with distance to transducer >2 cm or organized abscess. RESULTS Thirty patients (25 male) aged 60 ± 4.5 years (mean ± SD) had 4 prostatic abscesses, 7 perisigmoid abscesses, and 19 perirectal abscesses with mean ± SD sizes of 2.5 ± 0.3, 4.7 ± 0.6, and 5.4 ± 0.4 cm, respectively. Surgery was the most common predisposing factor (n = 14, 46.6 %) followed by diverticulitis (n = 5, 16.6 %). Interventions included aspiration only (2 prostatic and 3 perisigmoid), aspiration and dilatation (2 patients in each group), and dilatation and stenting (2 perisigmoid and 17 perirectal). Five (16.6 %) patients needed re-intervention, and two (6.6 %) needed surgery. There were no recurrences. Technical success of EUS-guided pelvic abscess drainage overall was 90.9 % (30/33) and was 93.3 % (27/30) in patients in whom EUS-guided drainage was attempted, with 16.5 % (n = 5) re-intervention rate. CONCLUSION EUS-guided drainage has an excellent success rate in drainage of pelvic abscesses.
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25
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Shahnazi M, Khatami A, Jamzad A, Shohitavi S. Safety and Efficacy of Percutaneous CT-Guided Drainage in the Management of Abdominopelvic Abscess. IRANIAN JOURNAL OF RADIOLOGY 2014; 11:e20876. [PMID: 25763077 PMCID: PMC4341169 DOI: 10.5812/iranjradiol.20876] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 11/21/2012] [Accepted: 01/10/2013] [Indexed: 12/29/2022]
Abstract
Background: Abdominopelvic fluid collection and abscess management and their outcomes have improved in the recent years due to innovation of the image-guided drainage technique and improvement of surgical procedures Objectives: This study was undertaken to evaluate the efficacy of CT-guided percutaneous drainage in treating abdominopelvic abscesses. Patients and Methods: In this study, the data of 41 patients who had abdominal abscess or fluid collections, and underwent treatment by percutaneous CT-guided drainage were analyzed. Treatment was assessed by reduction of collection size, relief of symptoms and signs including abdominal pain and fever and imaging findings. Any morbidity such as wound infection, sepsis, hematoma formation or peritonitis was followed up to six months after the procedure. Results: The average age of the patients was 54 years (range 12 to 79), including 21 (51%) men and 20 (49%) women. The common signs and symptoms were pain (83%) and fever (80.5%). The most prevalent abdominal abscess etiology was previous surgery in 31 cases (75.5%). Abscess diameter ranged between 5 and 12 cm (mean, 7.8 cm). The average hospital stay was 8 days (4-15). Thirty five cases (86%) were successfully treated. Only one case (2.5%) developed complication (peritonitis) after the procedure. Conclusions: According to our findings, CT-guided percutaneous drainage is a safe and effective procedure in the treatment of abdominal abscess and fluid collection.
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Affiliation(s)
- Makhtoom Shahnazi
- Department of Radiology, Loghman-e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Makhtoom Shahnazi, Department of Radiology, Loghman-e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-9121767478, E-mail:
| | - Alireza Khatami
- Department of Radiology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Jamzad
- Department of Radiology, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shomal Shohitavi
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Partecke LI, Müller A, Kessler W, Diedrich S, Heidecke CD, Patrzyk M, Mensel B. [Modern treatment of an appendiceal mass]. Chirurg 2014; 85:622-7. [PMID: 24449081 DOI: 10.1007/s00104-013-2657-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The recommendations for the treatment of an appendiceal mass are still controversial. The need for staged appendectomy is still under discussion. PATIENTS AND METHODS In a retrospective study all patients with the diagnosis appendiceal mass (ICD 10 K35.32) treated in the surgical clinic of the University Clinic in Greifswald between June 1999 and June 2011 were analyzed. RESULTS A total of 38 patients were included in the study whereby 17 patients (9 male and 8 female) were treated with drainage and antibiotics (group A) and 21 (14 male and 7 female) were treated by immediate surgery (group B). Nonsurgical therapy with drainage of the abscess was found to be efficient. Immediate surgical treatment was also effective and should be performed when signs of peritonitis exist. Interval appendectomy is not indicated.
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Affiliation(s)
- L I Partecke
- Klinik für Chirurgie, Abteilung für Allgemeine-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsmedizin Greifswald, Ferdinand Sauerbruchstr., 17475, Greifswald, Deutschland,
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Predictive factors for failure of percutaneous drainage of postoperative abscess after abdominal surgery. Am J Surg 2013; 207:915-21. [PMID: 24280147 DOI: 10.1016/j.amjsurg.2013.07.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/11/2013] [Accepted: 07/12/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aims of this study were to assess the efficacy of percutaneous drainage of postoperative abscess after abdominal surgery and to identify factors predictive of failed drainage. METHODS Data from 81 patients with postoperative abdominopelvic abscesses treated with percutaneous drainage were reviewed. Percutaneous drainage failure was considered when surgery was needed to control the sepsis. Predictive variables were sought using univariate and multivariate analyses with logistic regression models. RESULTS Successful drainage requiring 1 (n = 46) or 2 (n = 17) procedures was observed in 63 patients (78%; 95% confidence interval, 67%-86%). Surgery was needed in 18 patients (22%; 95% confidence interval, 14%-38%). Residual collection after a first percutaneous drainage was the single predictive factor for failed drainage on univariate and multivariate analyses (P = .0275). CONCLUSIONS Percutaneous imaging-guided drainage is a feasible and effective method for the treatment of abdominopelvic abscess, with a success rate of 78%. Residual collection is an independent predictor of unfavorable outcome after percutaneous drainage.
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28
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Postoperative fluid collections after colon resection: the utility of clinical assessment. Am J Surg 2013; 206:551-4. [DOI: 10.1016/j.amjsurg.2013.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 12/17/2012] [Accepted: 01/17/2013] [Indexed: 11/17/2022]
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Mauri G, Sconfienza LM, Fiore B, Brambilla G, Pedicini V, Poretti D, Lutman RF, Montorsi M, Sardanelli F. Post-surgical enteric fistula treatment with image-guided percutaneous injection of cyanoacrylic glue. Clin Radiol 2012; 68:59-63. [PMID: 22613168 DOI: 10.1016/j.crad.2012.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/22/2012] [Accepted: 04/03/2012] [Indexed: 12/13/2022]
Affiliation(s)
- G Mauri
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Italy.
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30
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Mezhir JJ. Management of complications following pancreatic resection: An evidence-based approach. J Surg Oncol 2012; 107:58-66. [DOI: 10.1002/jso.23139] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 04/09/2012] [Indexed: 12/19/2022]
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Kumar S, Karmakar D, Sharma JB, Kashinath JA. Treatment of typhoid perforation during pregnancy and the postpartum period. Int J Gynaecol Obstet 2011; 115:72-3. [PMID: 21794862 DOI: 10.1016/j.ijgo.2011.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/26/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
Affiliation(s)
- Sunesh Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Donkol RH, Latif NA, Moghazy K. Percutaneous imaging-guided interventions for acute biliary disorders in high surgical risk patients. World J Radiol 2010; 2:358-67. [PMID: 21160698 PMCID: PMC2998875 DOI: 10.4329/wjr.v2.i9.358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 08/20/2010] [Accepted: 08/27/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of percutaneous imaging-guided biliary interventions in the management of acute biliary disorders in high surgical risk patients.
METHODS: One hundred and twenty two patients underwent 139 percutaneous imaging-guided biliary interventions during the period between January 2007 to December 2009. The patients included 73 women and 49 men with a mean age of 61 years (range 35-90 years).
Fifty nine patients had acute biliary obstruction, 26 patients had acute biliary infection and 37 patients had abnormal collections. The procedures were performed under computed tomography (CT)- (73 patients), sonographic- (41 patients), and fluoroscopic-guidance (25 patients). Success rates and complications were determined. The χ2 test with Yates’ correction for continuity was applied to compare between these procedures. A P value < 0.05 was considered significant.
RESULTS: The success rates for draining acute biliary obstruction under CT- , fluoroscopy- or ultrasound-guidance were 93.3%, 62.5% and 46.1%, respectively with significant P values (P = 0.026 and 0.002, respectively). In acute biliary infection, successful drainage was achieved in 22 patients (84.6%). The success rates in patients drained under ultrasound- and CT-guidance were 46.1% and 88.8%, respectively and drainage under CT-guidance was significantly higher (P = 0.0293). In 13 patients with bilomas, percutaneous drainage was successful in 11 patients (84.6%). Ten out of 12 cases with hepatic abscesses were drained with a success rate of 83.3%. In addition, the success rate of drainage in 12 cases with pancreatic pseudocysts was 83.3%. The reported complications were two deaths, four major and seven minor complications.
CONCLUSION: Percutaneous imaging-guided biliary interventions help to promptly diagnose and effectively treat acute biliary disorders. They either cure the disorders or relieve sepsis and jaundice before operations.
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Fernandez-Urien I, Vila JJ, Jimenez FJ. Endoscopic ultrasound-guided drainage of pelvic collections and abscesses. World J Gastrointest Endosc 2010; 2:223-7. [PMID: 21160937 PMCID: PMC2998938 DOI: 10.4253/wjge.v2.i6.223] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/25/2010] [Accepted: 06/01/2010] [Indexed: 02/05/2023] Open
Abstract
Pelvic abscesses are usually the end stage in the progression of an infection. They may occur from surgical complications, generalized abdominal infections such as appendicitis or diverticulitis, or from localized infections such as pelvic inflammatory disease or inflammatory bowel disease. Although surgery has been considered as the treatment of choice by some authors, pelvic abscesses can be managed by non-invasive methods such as ultrasound and computed tomography-guided drainage. The development of therapeutic linear echoendoscopes has allowed the endoscopist to perform therapeutic procedures. Recently, endoscopic ultrasonography (EUS)-guided drainage of pelvic collections has been demonstrated to be feasible, efficient and safe. It allows the endoscopist to insert stents and drainage catheters into the abscess cavity which drains through the large bowel. This article reviews technique, current results and future prospects of EUS-guided drainage of pelvic lesions.
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Affiliation(s)
- Ignacio Fernandez-Urien
- Ignacio Fernandez-Urien, Juan J Vila, Francisco Javier Jimenez, Endoscopy Unit, Gastroenterology Department, Hospital de Navarra, Pamplona 31008, Spain
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