Iatrogenic Bowel Traversal during Percutaneous Drainage Catheter Placement: A Single-Center Retrospective Review of 3,507 Procedures

Abstract

Image-guided drainage catheter placement is a commonly performed procedure. While the complication rate is low, one potential complication is iatrogenic bowel traversal (IBT). Prior literature reported up to a 3.0% incidence of IBT events. This retrospective review examined image-guided percutaneous abscess catheter placements over 82 months to characterize the incidence, risk factors, and outcomes of IBT. Of 3,507 catheters placed, there were 13 IBT events, conferring a 0.4% incidence. Rates of IBT were similar whether ultrasound and fluoroscopy or computed tomography was utilized for placement. Of these 13 IBT events, 2 were transgastric, 1 was transcolonic, and 10 were through small bowel. Of these events, one patient died of vasopressor refractory septic shock, four underwent operative repair of the enterotomy, and eight were managed with catheter placement and gradual downsizing. The Society of Interventional Radiology Adverse Event Severity Scale was utilized to further categorize IBT events with observed severity ranging from moderate to life threatening. Although overall incidence has decreased since 35 years ago, IBT events are potentially life-threatening adverse events and further study to identify and minimize risk factors is essential.

Keywords

high-risk procedure - intra-abdominal abscess - percutaneous abscess drainage

Publication History

Received: 16 May 2022

Accepted: 12 July 2022

Article published online:
26 August 2022

• References

• 1 Gerzof SG, Robbins AH, Birkett DH, Johnson WC, Pugatch RD, Vincent ME. Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography. AJR Am J Roentgenol 1979; 133 (01) 1-8
• 2 Jaffe TA, Nelson RC. Image-guided percutaneous drainage: a review. Abdom Radiol (NY) 2016; 41 (04) 629-636
• 3 Politano AD, Hranjec T, Rosenberger LH, Sawyer RG, Tache Leon CA. Differences in morbidity and mortality with percutaneous versus open surgical drainage of postoperative intra-abdominal infections: a review of 686 cases. Am Surg 2011; 77 (07) 862-867
• 4 Maher MM, Gervais DA, Kalra MK. et al. The inaccessible or undrainable abscess: how to drain it. Radiographics 2004; 24 (03) 717-735
• 5 Lorenz J, Thomas JL. Complications of percutaneous fluid drainage. Semin Intervent Radiol 2006; 23 (02) 194-204
• 6 Maher MM, Kealey S, McNamara A, O'Laoide R, Gibney RG, Malone DE. Management of visceral interventional radiology catheters: a troubleshooting guide for interventional radiologists. Radiographics 2002; 22 (02) 305-322
• 7 van der Voort M, Heijnsdijk EA, Gouma DJ. Bowel injury as a complication of laparoscopy. Br J Surg 2004; 91 (10) 1253-1258
• 8 Mueller PR, Ferrucci Jr JT, Butch RJ, Simeone JF, Wittenberg J. Inadvertent percutaneous catheter gastroenterostomy during abscess drainage: significance and management. AJR Am J Roentgenol 1985; 145 (02) 387-391
• 9 Kumar A, Mehta D. Chilaiditi Syndrome. In: StatPearls. StatPearls Publishing; 2022
• 10 Khalilzadeh O, Baerlocher MO, Shyn PB. et al. Proposal of a new adverse event classification by the society of interventional radiology standards of practice committee. J Vasc Interv Radiol 2017; 28 (10) 1432-1437.e3
• 11 Bakal CW. Advances in imaging technology and the growth of vascular and interventional radiology: a brief history. J Vasc Interv Radiol 2003; 14 (07) 855-860
• 12 D'Agostino HB, vanSonnenberg E, Sanchez RB, Goodacre BW, Casola G. Imaging of the percutaneous cholecystostomy tract: observations and utility. Radiology 1991; 181 (03) 675-678
• 13 Akins EW, Hawkins Jr IF, Mladinich C, Tupler R, Siragusa RJ, Pry R. The blunt needle: a new percutaneous access device. AJR Am J Roentgenol 1989; 152 (01) 181-182
• 14 Epelboym Y, Shyn PB, Hosny A. et al. Use of a 3D-printed abdominal compression device to facilitate CT fluoroscopy-guided percutaneous interventions. AJR Am J Roentgenol 2017; 209 (02) 435-441