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Semin intervent Radiol 2024; 41(05): 435-443
DOI: 10.1055/s-0044-1791719
Review Article

Dispelling the Myths of Percutaneous Catheter Drainage of Infected Abdominal Collections

Jonathan M. Lorenz
1   Section of Interventional Radiology, The University of Chicago, Chicago, Illinois
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Abstract

When consulted for percutaneous catheter drainage (PCD) of abdominopelvic collections, interventional radiologists (IRs) should consider the appropriateness of this technique in the context of other options such as conservative, endoscopic, or surgical management. Whenever possible, published data should be considered prior to performing percutaneous drainage, especially as regards controversial scenarios such as the use of fibrinolytic therapy, the primary placement of large-bore drainage catheters, the drainage of cystic tumors, the drainage of splenic abscesses, and the treatment of collections lacking an in-line drainage window. This article examines past and present published data on PCD to dispel some common myths and guide IRs toward the best applications of PCD.

Keywords

abdominal abscess drainage - percutaneous abscess drainage - cystic tumors drainage - splenic abscess drainage - interventional radiology


Publication History

Article published online:
10 December 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Weiss CR, Bailey CR, Hohenwalter EJ. et al; Expert Panel on Interventional Radiology. ACR appropriateness criteria radiologic management of infected fluid collections. J Am Coll Radiol 2020; 17 (5S): S265-S280
    CrossrefPubMedSearch in Google Scholar
  • 2 Kumar RR, Kim JT, Haukoos JS. et al. Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum 2006; 49 (02) 183-189
    CrossrefPubMedSearch in Google Scholar
  • 3 Siewert B, Tye G, Kruskal J. et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol 2006; 186 (03) 680-686
    CrossrefPubMedSearch in Google Scholar
  • 4 Qin SL, Wang AX, Sheng RY, Liu ZY. [Clinical analysis of 36 cases with amebic liver abscess]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 2000; 18 (06) 356-358
    PubMedSearch in Google Scholar
  • 5 Donovan AJ, Yellin AE, Ralls PW. Hepatic abscess. World J Surg 1991; 15 (02) 162-169
    CrossrefPubMedSearch in Google Scholar
  • 6 Pitt HA. Surgical management of hepatic abscesses. World J Surg 1990; 14 (04) 498-504
    CrossrefPubMedSearch in Google Scholar
  • 7 Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. AJR Am J Roentgenol 2007; 189 (03) W138-42
    CrossrefPubMedSearch in Google Scholar
  • 8 Jaffe TA, Nelson RC, Delong DM, Paulson EK. Practice patterns in percutaneous image-guided intraabdominal abscess drainage: survey of academic and private practice centers. Radiology 2004; 233 (03) 750-756
    CrossrefPubMedSearch in Google Scholar
  • 9 Cinat ME, Wilson SE, Din AM. Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg 2002; 137 (07) 845-849
    CrossrefPubMedSearch in Google Scholar
  • 10 Wittich GR. Radiologic treatment of abdominal abscesses with fistulous communications. Curr Opin Radiol 1992; 4 (04) 110-115
    PubMedSearch in Google Scholar
  • 11 Schuster MR, Crummy AB, Wojtowycz MM, McDermott JC. Abdominal abscesses associated with enteric fistulas: percutaneous management. J Vasc Interv Radiol 1992; 3 (02) 359-363
    CrossrefPubMedSearch in Google Scholar
  • 12 Do H, Lambiase RE, Deyoe L, Cronan JJ, Dorfman GS. Percutaneous drainage of hepatic abscesses: comparison of results in abscesses with and without intrahepatic biliary communication. AJR Am J Roentgenol 1991; 157 (06) 1209-1212
    CrossrefPubMedSearch in Google Scholar
  • 13 Akhan O, Erdoğan E, Ciftci TT, Unal E, Karaağaoğlu E, Akinci D. Comparison of the long-term results of puncture, aspiration, injection and re-aspiration (PAIR) and catheterization techniques for the percutaneous treatment of CE1 and CE3a liver hydatid cysts: a prospective randomized trial. Cardiovasc Intervent Radiol 2020; 43 (07) 1034-1040
    CrossrefPubMedSearch in Google Scholar
  • 14 Greenstein Y, Shah AJ, Vragovic O. et al. Tuboovarian abscess. Factors associated with operative intervention after failed antibiotic therapy. J Reprod Med 2013; 58 (3-4): 101-106
    PubMedSearch in Google Scholar
  • 15 Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv 2009; 64 (10) 681-689
    CrossrefPubMedSearch in Google Scholar
  • 16 Bouali K, Magotteaux P, Jadot A. et al. Percutaneous catheter drainage of abdominal abscess after abdominal surgery. Results in 121 cases. J Belge Radiol 1993; 76 (01) 11-14
    PubMedSearch in Google Scholar
  • 17 Benoist S, Panis Y, Pannegoeon V. et al. Can failure of percutaneous drainage of postoperative complicated intra-abdominal abscesses be predicted?. Am J Surg 2002; 184: 148-153
    CrossrefPubMedSearch in Google Scholar
  • 18 Luo CC, Cheng KF, Huang CS. et al. Therapeutic effectiveness of percutaneous drainage and factors for performing an interval appendectomy in pediatric appendiceal abscess. BMC Surg 2016; 16 (01) 72
    CrossrefPubMedSearch in Google Scholar
  • 19 Fabiszewski NL, Sumkin JH, Johns CM. Contemporary radiologic percutaneous abscess drainage in the pelvis. Clin Obstet Gynecol 1993; 36 (02) 445-456
    CrossrefPubMedSearch in Google Scholar
  • 20 Gervais DA, Hahn PF, O'Neill MJ, Mueller PR. Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years. Radiology 2002; 222 (03) 645-651
    CrossrefPubMedSearch in Google Scholar
  • 21 Müller-Wille R, Iesalnieks I, Dornia C. et al. Influence of percutaneous abscess drainage on severe postoperative septic complications in patients with Crohn's disease. Int J Colorectal Dis 2011; 26 (06) 769-774
    CrossrefPubMedSearch in Google Scholar
  • 22 Poritz LS, Koltun WA. Percutaneous drainage and ileocolectomy for spontaneous intraabdominal abscess in Crohn's disease. J Gastrointest Surg 2007; 11 (02) 204-208
    CrossrefPubMedSearch in Google Scholar
  • 23 Hatjidakis AA, Karampekios S, Prassopoulos P. et al. Maturation of the tract after percutaneous cholecystostomy with regard to the access route. Cardiovasc Intervent Radiol 1998; 21 (01) 36-40
    CrossrefPubMedSearch in Google Scholar
  • 24 Rassameehiran S, Tantrachoti P, Nugent K. Percutaneous gallbladder aspiration for acute cholecystitis. Proc Bayl Univ Med Cent 2016; 29 (04) 381-384
    CrossrefPubMedSearch in Google Scholar
  • 25 Rosiak G, Franke J, Milczarek K, Konecki D, Wnuk E. Effectiveness and safety of CT-guided drainage of abdominal abscesses with small and extra-small-bore drains: a single-centre observational study. Pol J Radiol 2024; 89: e156-e160
    CrossrefPubMedSearch in Google Scholar
  • 26 Gobien RP, Stanley JH, Schabel SI. et al. The effect of drainage tube size on adequacy of percutaneous abscess drainage. Cardiovasc Intervent Radiol 1985; 8 (02) 100-102
    CrossrefPubMedSearch in Google Scholar
  • 27 Röthlin MA, Schöb O, Klotz H, Candinas D, Largiadèr F. Percutaneous drainage of abdominal abscesses: are large-bore catheters necessary?. Eur J Surg 1998; 164 (06) 419-424
    CrossrefPubMedSearch in Google Scholar
  • 28 Rotman JA, Getrajdman GI, Maybody M. et al. Effect of abdominopelvic abscess drain size on drainage time and probability of occlusion. Am J Surg 2017; 213 (04) 718-722
    CrossrefPubMedSearch in Google Scholar
  • 29 Puri R, Eloubeidi MA, Sud R, Kumar M, Jain P. Endoscopic ultrasound-guided drainage of pelvic abscess without fluoroscopy guidance. J Gastroenterol Hepatol 2010; 25 (08) 1416-1419
    CrossrefPubMedSearch in Google Scholar
  • 30 Kok KY, Yapp SK. Laparoscopic drainage of postoperative complicated intra-abdominal abscesses. Surg Laparosc Endosc Percutan Tech 2000; 10 (05) 311-313
    CrossrefPubMedSearch in Google Scholar
  • 31 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
    CrossrefPubMedSearch in Google Scholar
  • 32 Schweiger GD, Yip VY, Brown BP. CT fluoroscopic guidance for percutaneous needle placement into abdominopelvic lesions with difficult access routes. Abdom Imaging 2000; 25 (06) 633-637
    CrossrefPubMedSearch in Google Scholar
  • 33 Nawfel RD, Judy PF, Silverman SG, Hooton S, Tuncali K, Adams DF. Patient and personnel exposure during CT fluoroscopy-guided interventional procedures. Radiology 2000; 216 (01) 180-184
    CrossrefPubMedSearch in Google Scholar
  • 34 Yamakado K, Takaki H, Nakatsuka A. et al. Percutaneous transhepatic drainage of inaccessible abdominal abscesses following abdominal surgery under real-time CT-fluoroscopic guidance. Cardiovasc Intervent Radiol 2010; 33 (01) 161-163
    CrossrefPubMedSearch in Google Scholar
  • 35 Arellano RS, Gervais DA, Mueller PR. CT-guided drainage of abdominal abscesses: hydrodissection to create access routes for percutaneous drainage. AJR Am J Roentgenol 2011; 196 (01) 189-191
    CrossrefPubMedSearch in Google Scholar
  • 36 Tyng CJ, Amoedo MK, Bohrer Y. et al. A new CT-guided modified trocar technique for drainage of difficult locations abscesses. Cardiovasc Intervent Radiol 2017; 40 (05) 769-775
    CrossrefPubMedSearch in Google Scholar
  • 37 Sze DY. Use of curved needles to perform biopsies and drainages of inaccessible targets. J Vasc Interv Radiol 2001; 12 (12) 1441-1444
    CrossrefPubMedSearch in Google Scholar
  • 38 Young AS, Shyn PB, Johnson OW, Sainani NI, Nawfel RD, Silverman SG. Bending percutaneous drainage catheters to facilitate CT-guided insertion using curved trocar technique. Abdom Radiol (NY) 2017; 42 (08) 2160-2167
    CrossrefPubMedSearch in Google Scholar
  • 39 Lee HN, Hyun D, Lee WH, Kim JG, Kim HJ. Modified surgical drain-guided percutaneous catheter drainage of postoperative fluid collection in inaccessible locations. J Vasc Interv Radiol 2022; 33 (12) 1500-1506
    CrossrefPubMedSearch in Google Scholar
  • 40 Ciftci TT, Akinci D, Akhan O. Percutaneous transhepatic drainage of inaccessible postoperative abdominal abscesses. AJR Am J Roentgenol 2012; 198 (02) 477-481
    CrossrefPubMedSearch in Google Scholar
  • 41 Ballard DH, Gates MC, Hamidian Jahromi A, Harper DV, Do DV, D'Agostino HB. Transrectal and transvaginal catheter drainages and aspirations for management of pelvic fluid collections: technique, technical success rates, and outcomes in 150 patients. Abdom Radiol (NY) 2019; 44 (07) 2582-2593
    CrossrefPubMedSearch in Google Scholar
  • 42 Beland MD, Gervais DA, Levis DA, Hahn PF, Arellano RS, Mueller PR. Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology 2008; 247 (02) 567-573
    CrossrefPubMedSearch in Google Scholar
  • 43 Falsarella PM, Rocha RD, Rahal Junior A, Mendes GF, Garcia RG. Minimally invasive treatment of complex collections: safety and efficacy of recombinant tissue plasminogen activator as an adjuvant to percutaneous drainage. Radiol Bras 2018; 51 (04) 231-235
    CrossrefPubMedSearch in Google Scholar
  • 44 Lahorra JM, Haaga JR, Stellato T, Flanigan T, Graham R. Safety of intracavitary urokinase with percutaneous abscess drainage. AJR Am J Roentgenol 1993; 160 (01) 171-174
    CrossrefPubMedSearch in Google Scholar
  • 45 Diamond IR, Wales PW, Connolly B, Gerstle T. Tissue plasminogen activator for the treatment of intraabdominal abscesses in a neonate. J Pediatr Surg 2003; 38 (08) 1234-1236
    CrossrefPubMedSearch in Google Scholar
  • 46 Cheng D, Nagata KT, Yoon HC. Randomized prospective comparison of alteplase versus saline solution for the percutaneous treatment of loculated abdominopelvic abscesses. J Vasc Interv Radiol 2008; 19 (06) 906-911
    CrossrefPubMedSearch in Google Scholar
  • 47 St Peter SD, Shah SR, Adibe OO. et al. Saline vs tissue plasminogen activator irrigations after drain placement for appendicitis-associated abscess: a prospective randomized trial. J Am Coll Surg 2015; 221 (02) 390-396
    CrossrefPubMedSearch in Google Scholar
  • 48 Laborda A, De Gregorio MA, Miguelena JM. et al. Percutaneous treatment of intrabdominal abscess: urokinase versus saline serum in 100 cases using two surgical scoring systems in a randomized trial. Eur Radiol 2009; 19 (07) 1772-1779
    CrossrefPubMedSearch in Google Scholar
  • 49 Gibson CR, Amirabadi A, Goman S. et al. Use of tissue plasminogen activator in abdominal abscesses in children-a single-center randomized control trial. Can Assoc Radiol J 2021; 72 (03) 577-584
    CrossrefPubMedSearch in Google Scholar
  • 50 Zahedi R, Uppal S, Mendiratta-Lala M, Higgins EJ, Nettles AN, Maturen KE. Percutaneous image-guided pelvic procedures in women with gynecologic cancers: utilization, complications, and impact on patient management. Abdom Radiol (NY) 2016; 41 (12) 2460-2465
    CrossrefPubMedSearch in Google Scholar
  • 51 Mueller PR, White EM, Glass-Royal M. et al. Infected abdominal tumors: percutaneous catheter drainage. Radiology 1989; 173 (03) 627-629
    CrossrefPubMedSearch in Google Scholar
  • 52 Ballard DH, Mokkarala M, D'Agostino HB. Percutaneous drainage and management of fluid collections associated with necrotic or cystic tumors in the abdomen and pelvis. Abdom Radiol (NY) 2019; 44 (04) 1562-1566
    CrossrefPubMedSearch in Google Scholar
  • 53 Chang YC, Lin YM. Bronchobiliary fistula after radiofrequency ablation for hepatocellular carcinoma successfully treated by double drainage. Respirol Case Rep 2018; 6 (09) e00376
    CrossrefPubMedSearch in Google Scholar
  • 54 Abdurabuh E, Khairo M, Bakhsh A, Alsharif M, AlYamani W. Use heat with caution! Pleurobiliary fistula after hepatocellular carcinoma microwave ablation in lymphoma patient: A case study. Radiol Case Rep 2022; 17 (10) 3871-3876
    CrossrefPubMedSearch in Google Scholar
  • 55 Su XF, Li N, Chen XF, Zhang L, Yan M. Incidence and risk factors for liver abscess after thermal ablation of liver neoplasm. Hepat Mon 2016; 16 (07) e34588
    PubMedSearch in Google Scholar
  • 56 Choi D, Lim HK, Kim MJ. et al. Liver abscess after percutaneous radiofrequency ablation for hepatocellular carcinomas: frequency and risk factors. AJR Am J Roentgenol 2005; 184 (06) 1860-1867
    CrossrefPubMedSearch in Google Scholar
  • 57 Devulapalli KK, Fidelman N, Soulen MC. et al. 90Y Radioembolization for Hepatic Malignancy in Patients with Previous Biliary Intervention: Multicenter Analysis of Hepatobiliary Infections. Radiology 2018; 288 (03) 774-781
    CrossrefPubMedSearch in Google Scholar
  • 58 Choudhury SR, Debnath PR, Jain P. et al. Conservative management of isolated splenic abscess in children. J Pediatr Surg 2010; 45 (02) 372-375
    CrossrefPubMedSearch in Google Scholar
  • 59 Tung CC, Chen FC, Lo CJ. Splenic abscess: an easily overlooked disease?. Am Surg 2006; 72 (04) 322-325
    CrossrefPubMedSearch in Google Scholar
  • 60 Chang KC, Chuah SK, Changchien CS. et al. Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. World J Gastroenterol 2006; 12 (03) 460-464
    CrossrefPubMedSearch in Google Scholar
  • 61 Statler JD, Doherty RD, McLaughlin JJ, Gleason JD, McDermott MP. Tissue plasminogen activator in the percutaneous drainage of splenic abscess. J Vasc Interv Radiol 2010; 21 (02) 307-309
    CrossrefPubMedSearch in Google Scholar