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Al-Khafaji MQ, Al-Smadi MW, Al-Khafaji MQ, Aslan S, Al-Khafaji YQ, Bagossy-Blás P, Al Nasser MH, Horváth BL, Viola Á. Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review. J Clin Med 2024; 13:3199. [PMID: 38892910 PMCID: PMC11173313 DOI: 10.3390/jcm13113199] [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: 04/15/2024] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.
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Affiliation(s)
- Murtadha Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Mohammad Walid Al-Smadi
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
| | - Mustafa Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Siran Aslan
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
- Doctoral School of Clinical Medicine, Semmelweis University, 1083 Budapest, Hungary
| | - Yousif Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Panna Bagossy-Blás
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
| | - Mohammad Hakem Al Nasser
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Bálint László Horváth
- Department of Traumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary;
| | - Árpád Viola
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
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Zhang Y, Wang Z, Basharat Z, Hu M, Hong W, Chen X. Nomogram of intra-abdominal infection after surgery in patients with gastric cancer: A retrospective study. Front Oncol 2022; 12:982807. [PMID: 36263227 PMCID: PMC9574043 DOI: 10.3389/fonc.2022.982807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Surgical resection is still the primary way to treat gastric cancer. Therefore, postoperative complications such as IAI (intra-abdominal infection) are major problems that front-line clinical workers should pay special attention to. This article was to build and validate IAI’s RF (regression function) model. Furthermore, it analyzed the prognosis in patients with IAI after surgery for stomach cancer. The above two points are our advantages, which were not involved in previous studies. Methods The data of this study was divided into two parts, the training data set and the validation data set. The training data for this article were from the patients treated surgically with gastric cancer in our center from December 2015 to February 2017. We examined IAI’s morbidity, etiological characteristics, and prognosis in the training data set. Univariate and multivariate logistic regression analyses were used to screen risk factors, establish an RF model and create a nomogram. Data from January to March 2021 were used to validate the accuracy of the RF model. Results The incidence of IAI was 7.2%. The independent risk factors for IAI were hypertension (Odds Ratio [OR] = 3.408, P = 0.001), history of abdominal surgery (OR = 2.609, P = 0.041), combined organ excision (OR = 4.123, P = 0.010), and operation time ≥240 min (OR = 3.091, P = 0.005). In the training data set and validation data set, the area under the ROC curve of IAI predicted by the RF model was 0.745 ± 0.048 (P<0.001) and 0.736 ± 0.069 (P=0.003), respectively. In addition, IAI significantly extended the length of hospital stay but had little impact on survival. Conclusions Patients with hypertension, combined organ excision, a history of abdominal surgery, and a surgical duration of 240 min or more are prone to IAI, and the RF model may help to identify them.
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Affiliation(s)
- Yue Zhang
- Department of Otolaryngology, Wenzhou People’s Hospital, Wenzhou, China
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhengfei Wang
- Department of Hepato-biliary Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China
| | - Zarrin Basharat
- Jamil-ur-Rahman Center for Genome Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Mengjun Hu
- Department of Pathology, Zhuji Affiliated Hospital of Wenzhou Medical University, Shaoxing, China
- *Correspondence: Mengjun Hu, ; Wandong Hong, ; Xiangjian Chen,
| | - Wandong Hong
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Mengjun Hu, ; Wandong Hong, ; Xiangjian Chen,
| | - Xiangjian Chen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Mengjun Hu, ; Wandong Hong, ; Xiangjian Chen,
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Gleason TG, Pruett TL, Sawyer RG. Intra-Abdominal Abscesses: Emphasis on Image-Guided Diagnosis and Therapy. J Intensive Care Med 2016. [DOI: 10.1177/088506669801300606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infection of the peritoneal cavity can be divided into acute peritonitis and chronic abscess formation. While acute peritonitis is easier to diagnose and treatment is often straightforward, the diagnosis of an intra-abdominal abscess can be subtle and treatment can involve multiple diagnostic and therapeutic modalities. The advent of high-quality computed tomography and ultrasonography has revolutionized the care of these patients, and has allowed for the definitive management of these infections without open operation. We review the current techniques for the diagnosis, localization, and treatment of these serious infections, discuss important factors influencing the decision between percutaneous and operative approaches, and examine several other controversies In this challenging area.
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Affiliation(s)
- Thomas G. Gleason
- Charles O. Strickler Transplant Center, University of Virginia Department of Surgery, Charlottesville, VA
| | - Timothy L. Pruett
- Charles O. Strickler Transplant Center, University of Virginia Department of Surgery, Charlottesville, VA
| | - Robert G. Sawyer
- Charles O. Strickler Transplant Center, University of Virginia Department of Surgery, Charlottesville, VA,
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Tikkakoski T, Siniluoto T, Päivänsalo M, Taavitsainen M, Leppänen M, Dean K, Koivisto M, Suramo I. Splenic Abscess. Acta Radiol 2016. [DOI: 10.1177/028418519203300613] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We reviewed the imaging findings of 14 splenic abscesses in 13 patients. All patients underwent chest radiography, 12 ultrasonography (US), 9 CT, 4 plain abdominal radiography, 2 99mTc-HMPAO leukocyte scan and 2 99mTc-HIG scan. Three patients were treated with percutaneous catheter drainage, and 5 with diagnostic or therapeutic fine-needle aspiration (FNA). At US the abscess was hypoechoic (n = 9), anechoic (n = 2), or anechoic with gasbubbles (n = 1), or the entire spleen was inhomogeneous with gasbubbles (n = 1). At CT the abscesses appeared as low density (18–30 HU) lesions with (n = 2) or without (n = 7) gas. In 2 cases 99mTc-HMPAO leukocyte scan, and in one case 99mTc-HIG scan showed an intrasplenic defect, and in one case 99mTc-HIG scan was considered normal. At plain abdominal radiography extraintestinal gas was suggested in 2 patients, and the findings were normal in 2. US-guided FNA confirmed infectious etiology of the lesion in 4 patients, and a necrotic specimen suggested infection in one. One patient was cured with repeated aspirations. Catheter drainage was successful in all 3 patients who underwent the procedure. We conclude that US and CT are accurate in detecting splenic abscesses. Our results in splenic interventions advocate wider use of the procedures.
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Terzi HA, Demiray T, Koroglu M, Cakmak G, Hakki Ciftci I, Ozbek A, Altindis M. Intra-Abdominal Abscess and Primary Peritonitis Caused by Streptococcus anginosus. Jundishapur J Microbiol 2016; 9:e33863. [PMID: 27630763 PMCID: PMC5011413 DOI: 10.5812/jjm.33863] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction The Streptococcus anginosus group of bacteria are low-virulence bacteria existing as commensals in the oral flora and gastrointestinal tracts of humans. S. anginosus may spread to the blood in individuals with poor oral hygiene in cases of oral infections, such as gingivitis and tooth abscesses, that develop following the loss of mucosal unity. This may lead to infections in the whole body, primarily as brain and liver abscesses. Case Presentation A 32-year-old male patient presented with complaints of nausea, vomiting, and diffuse abdominal pain. Diffuse abdominal tenderness and rebound tenderness were detected particularly in the epigastrium and right upper quadrant. Laboratory assessment revealed a leukocyte count of 20,500/mm3. Free fluid around the liver and heterogeneous areas of abscess formation in the right lateral gallbladder were revealed on abdominal computed tomography. Diffuse adhesions between the bowel and seropurulent free liquid in the abdomen were detected on surgical exploration, and a sample was taken for cultures. The patient was discharged without complications on the sixth postoperative day and his antibiotic course was completed with 4 weeks of oral treatment. We reviewed the literature for similar cases of disseminated pyogenic infections caused by the S. anginosus group. Conclusions It should be kept in mind that the oral flora bacterium S. anginosus may cause transient bacteremia and deep-seated organ abscesses in immunodeficient patients with poor oral hygiene. Such patients with intra-abdominal abscesses should be treated with antibiotics and surgery.
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Affiliation(s)
- Huseyin Agah Terzi
- Department of Clinical Microbiology, Sakarya Training and Research Hospital, Sakarya, Turkey
- Corresponding author: Huseyin Agah Terzi, Department of Clinical Microbiology, Sakarya Training and Research Hospital, Sakarya, Turkey. Tel: +90-5364628654, Fax: +90-2642759192, E-mail:
| | - Tayfur Demiray
- Department of Clinical Microbiology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Mehmet Koroglu
- Department of Clinical Microbiology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Guner Cakmak
- Department of General Surgery, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Ihsan Hakki Ciftci
- Department of Clinical Microbiology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Ahmet Ozbek
- Department of Clinical Microbiology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Mustafa Altindis
- Department of Clinical Microbiology, Sakarya Training and Research Hospital, Sakarya, Turkey
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Cargill T, Gupta V, Thomas P. Pyogenic iliopsoas abscess: An uncommon presentation of nonspecific leg pain. J Acute Med 2014. [DOI: 10.1016/j.jacme.2013.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Impact of Surgical Infection Society/Infectious Disease Society of America-recommended antibiotics on postoperative intra-abdominal abscess with image-guided percutaneous abscess drainage following gastrointestinal surgery. Surg Today 2014; 45:993-1000. [PMID: 25326250 DOI: 10.1007/s00595-014-1047-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/06/2014] [Indexed: 12/29/2022]
Abstract
PURPOSE The aims of this study were to reveal how using the antibiotics recommended by the 2010 Surgical Infection Society (SIS) and Infectious Disease Society of America (IDSA) guidelines can affect the therapeutic outcomes. METHODS We reviewed the cases of 53 patients with a postoperative intra-abdominal abscess without anastomotic leakage after gastrointestinal surgery who underwent image-guided percutaneous abscess drainage (PAD) and concomitant antibiotic therapy. The type of antibiotic initially administered was determined based on the surgeon's judgment. A persistent abscess was defined as one or more PAD procedures resulting in complete resolution after 21 or more days. The recommended antibiotics were defined according to 2010 SIS/IDSA guidelines. RESULTS All 53 patients had complete resolution without the need for surgery. The results of a multivariable analysis revealed that a C-reactive protein level ≥12 mg/dL and non-recommended antibiotics were significant risk factors for a persistent abscess (P = 0.042 and 0.013, respectively). With regard to a fever lasting more than 48 h, there was a significant difference between the recommended (45.1%) and non-recommended (72.7 %) antibiotic groups (P = 0.046). CONCLUSIONS Using the recommended antibiotics may shorten the time to defervescence and reduce the risk of a persistent abscess in patients undergoing PAD for a postoperative abscess after gastrointestinal surgery.
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Okita Y, Mohri Y, Kobayashi M, Araki T, Tanaka K, Inoue Y, Uchida K, Yamakado K, Takeda K, Kusunoki M. Factors influencing the outcome of image-guided percutaneous drainage of intra-abdominal abscess after gastrointestinal surgery. Surg Today 2013; 43:1095-102. [PMID: 23408085 PMCID: PMC3779006 DOI: 10.1007/s00595-013-0504-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/19/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE To improve the selection of patients for percutaneous abscess drainage (PAD) to treat postoperative intra-abdominal abscess after gastrointestinal surgery, we investigated the factors predictive of outcome. METHODS Of 143 consecutive patients with symptomatic postoperative intra-abdominal abscess after a gastrointestinal tract resection, 104 who underwent image-guided PAD as the initial treatment were reviewed. We assessed the possible associations between successful PAD and patient-, abscess-, surgical-, and drainage-related variables, and investigated the success rates of PAD for patients with vs. those without the factors related to successful outcome. RESULTS Based on monitoring for 1 year after PAD, the success rate of this procedure was 85.6% (89/104). Multivariate analysis revealed that the interval between surgery and the onset of abscess (p = 0.0234) and a single abscess (p = 0.0038) were independently associated with a successful outcome. Single late-onset abscess resolved completely within 10 weeks in 91.4% of these patients. CONCLUSIONS Despite new strategies aimed at preventing surgical site infection, PAD remains an important factor in the postoperative management of gastrointestinal surgery in Japan. Initial recognition of the day of onset and the number of abscesses are important prognostic factors.
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Affiliation(s)
- Yoshiki Okita
- Departments of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan,
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Yildiz M, Karakayali AS, Ozer S, Ozer H, Demir A, Kaptanoglu B. Acute appendicitis presenting with abdominal wall and right groin abscess: A case report. World J Gastroenterol 2007; 13:3631-3. [PMID: 17659716 PMCID: PMC4146805 DOI: 10.3748/wjg.v13.i26.3631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.
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Affiliation(s)
- Mustafa Yildiz
- Department of General Surgery, Ministry of Health Ankara Training and Research Hospital, Ulucanlar, Ankara, Turkey.
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Cai T, Giubilei G, Vichi F, Farina U, Costanzi A, Bartoletti R. A rare case of lethal retroperitoneal abscess caused by Citrobacter koseri. Urol Int 2007; 79:364-366. [PMID: 18025858 DOI: 10.1159/000109725] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 12/21/2005] [Indexed: 11/19/2022]
Abstract
Retroperitoneal abscesses are very uncommon clinical conditions. The characteristically vague symptomatology of retroperitoneal abscess and the inherent difficulty of identifying retroperitoneal disease by physical examination contributed to these dismal therapeutic outcomes. We present an unusual case of lethal retroperitoneal abscess, caused by Citrobacter diversus(koseri), treated with surgical drainage. Citrobacter species have rarely been involved in deep tissue infection and there is no reported case of lethal retroperitoneal abscess caused by C. koseri. This case is the only reported case of C. koseri as the sole pathogen associated with a lethal retroperitoneal abscess in immunocompetent patient. The case is also notable because it confirms the recent bacterial resistance to beta-lactam antibiotics and to other antimicrobial agents, like chloramphenicol or cotrimoxazol.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, University of Florence, Florence, Italy.
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Hsieh CH, Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ. Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: An extremely fulminant form of a common disease. World J Gastroenterol 2006; 12:496-9. [PMID: 16489659 PMCID: PMC4066078 DOI: 10.3748/wjg.v12.i3.496] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As a disease commonly encountered in daily practice, acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity rate. However, acute appendicitis may occasionally become extraordinarily complicated and life threatening. A 56-year-old man, healthy prior to this admission, was brought to the hospital due to spiking high fever, poor appetite, dysuria, progressive right flank and painful swelling of the thigh for 3 d. Significant inflammatory change of soft tissue was noted, involving the entire right trunk from the subcostal margin to the knee joint. Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated C-reactive protein level. Abdominal CT revealed several communicated gas-containing abscesses at the right retroperitoneal region with mass effect, pushing the duodenum and the pancreatic head upward, compressing and encasing inferior vena cava, destroying psoas muscle and dissecting downward into the right thigh. Laparotomy and right thigh exploration were performed immediately and about 500 mL of frank pus was drained. A ruptured retrocecal appendix was the cause of the abscess. The patient fully recovered at the end of the third post-operation week. This case reminds us that acute appendicitis should be treated carefully on an emergency basis to avoid serious complications. CT scan is the diagnostic tool of choice, with rapid evaluation followed by adequate drainage as the key to the survival of the patient.
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Affiliation(s)
- Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan, China
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Abstract
OBJECTIVE In this article, I describe a percutaneous drainage needle that consists of six side holes in its cannula. The needle is specially designed for effective evacuation of complex abscess collections consisting of internal solid components, including floating debris, that tend to block the needle aperture during aspiration. The characteristic features of the needle and its performance in both in vitro and in vivo environments are described. MATERIALS AND METHODS An in vitro experiment was performed with the use of a model of a fluid collection containing floating sheets of gelatin sponge to mimic a complex body collection consisting of floating fibrinous strands. Five radiologists were asked to perform aspiration from two collections of normal saline and 5% methylcellulose of two different volumes using an ordinary aspiration needle and the drainage needle. The needle was evaluated in a prospective in vivo study of 30 postoperative abdominal collections in 29 consecutive patients that were drained by a single radiologist. Complete evacuation was attempted initially with a conventional aspiration needle. When there was sonographic evidence of residual fluid collection, a repeat aspiration using a drainage needle was performed during the same session. RESULTS In the in vitro experiment, the median percentage of fluid aspirated with the conventional needle from the 10- and 15-mL collections of saline was 10% and 15% and from the 10 mL and 15 mL of methylcellulose solution was 20% and 26.67%, respectively, whereas the drainage needle was able to remove 100% of fluid in all attempts. In the in vivo study, the conventional needle was able to remove all drainable fluid from the 12 simple collections. For the 18 complex collections, the drainage needle was always able to remove some residual fluid from the collection after aspiration with the conventional needle. The median percentage of fluid volume aspirated with the conventional needle was 55.6%, whereas that aspirated with both the conventional and drainage needles was 95.5%, with a significant difference by Wilcoxon's signed rank test (p < 0.001). CONCLUSION This drainage needle was effective in evacuating fluid from complex abdominal collections that could not be drained with conventional end-hole needles.
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Affiliation(s)
- Simon C H Yu
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St., Shatin, Hong Kong, China.
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Abstract
Iliopsoas abscess is a relatively uncommon condition that can present with vague clinical features. Its insidious onset and occult characteristics can cause diagnostic delays, resulting in high mortality and morbidity. The epidemiology, aetiology, clinical features, and management of iliopsoas abscess are discussed.
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Affiliation(s)
- I H Mallick
- University Department of Surgery, Royal Free and University College Medical School, Hampstead, London NW3 2QG, UK.
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Benoist S, Panis Y, Pannegeon V, Soyer P, Watrin T, Boudiaf M, Valleur P. Can failure of percutaneous drainage of postoperative abdominal abscesses be predicted? Am J Surg 2002; 184:148-53. [PMID: 12169359 DOI: 10.1016/s0002-9610(02)00912-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Percutaneous drainage (PD) of complex postoperative abscesses associated with a variety of factors such as multiple location or enteric fistula remains a matter of debate. Accordingly, this retrospective study was designed to determine the predictive factors for failure of PD of postoperative abscess, in order to better select the patients who may benefit from PD. METHODS From 1992 to 2000, the data of 73 patients who underwent computed tomography (CT)-guided PD for postoperative intra-abdominal abscess, were reviewed. PD was considered as failure when clinical sepsis persisted or subsequent surgery was needed. The possible association between failure of PD and 27 patient-, abscess-, surgical-, and drainage-related variables were assessed using univariate and multivariate analysis. RESULTS Successful PD was achieved in 59 of 73 (81%) patients. The overall mortality was 3% but no patient died after salvage surgery. Multivariate analysis showed that only an abscess diameter of less than 5 cm (P = 0.042) and absence of antibiotic therapy (P = 0.01) were significant predictive variables for failure of PD. CONCLUSIONS CT-guided PD associated with antibiotic therapy could be attempted as the initial treatment of postoperative abdominal abscesses even in complex cases such as loculated abscess or abscess associated with enteric fistula.
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Affiliation(s)
- Stéphane Benoist
- Department of Surgery, Service de Chirurgie Générale et Digestive, Hôpital Lariboisière, Paris, France
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Gleason TG, Pruett TL, Sawyer RG. Intra-Abdominal Abscesses: Emphasis on Image-Guided Diagnosis and Therapy. J Intensive Care Med 1998. [DOI: 10.1046/j.1525-1489.1998.00320.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The basic principles for treating intraabdominal infections are fourfold: (1) to obliterate the infectious source; (2) to purge bacteria and toxins; (3) to maintain organ system function and (4) to tame the inflammatory process. Operative and nonoperative treatment options are available. Operative therapy includes different strategies: (1) the standard operation; (2) advanced procedures to decompress the abdominal compartment syndrome and (3) percutaneous drainage of abscesses. Nonoperative management includes: (1) antibiotic therapy; (2) hemodynamic and pulmonary support; (3) nutrition and metabolic support; (4) detoxification support (including support of renal and hepatic function) and (5) inflammation modulating therapy. Standard operative management addresses the first two principles and has been shown to reduce mortality by more than 50%. A recent extensive series of studies reports mortality rates around 20%. Patients with an abdominal compartment syndrome (intraabdominal pressure over 25 torr) and patients with advanced disease and compounding risk factors best documented by high APACHE-II scores are candidates for more advanced operations. The mortality rate following abdominostomy (leaving the abdomen open) in 869 patients participating in 37 studies was 42%, when the abdomen was simply left open for decompression (open abdominostomy). When a mesh was used to cover the abdominal wound (mesh abdominostomy) 39% of 439 patients enrolled in 12 studies died. Patients who underwent staged abdominal repair (STAR abdominostomy) faired better. Of 385 patients in 11 studies 28% died. Data from antibiotic studies as well as from immunomodulating therapy are nonconclusive at this point with respect to reducing mortality in intraabdominal infection.
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Affiliation(s)
- D H Wittmann
- Dept. of Surgery, Medical College of Wisconsin, Milwaukee 53226, USA
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Bernini A, Spencer MP, Wong WD, Rothenberger DA, Madoff RD. Computed tomography-guided percutaneous abscess drainage in intestinal disease: factors associated with outcome. Dis Colon Rectum 1997; 40:1009-13. [PMID: 9293926 DOI: 10.1007/bf02050920] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to assess the efficacy of computed tomography-guided percutaneous abscess drainage in intestinal disease. METHODS Retrospective chart review of patients who underwent percutaneous abscess drainage for complications of intestinal disease with or without surgery between 1990 and 1994. RESULTS Eighty-two patients with 111 abscesses were identified. Causes of abscess included anastomotic leaks (35 percent), postoperative complications without leak (30 percent), and diverticular disease (23 percent). Complete success (no surgery necessary) was achieved in 53 of 82 patients (65 percent). Nine patients (11 percent) who underwent interval surgery were classified as having partial successes. Twenty-six of 26 (100 percent) well-defined unilocular collections containing pus were successfully drained. Complex abscesses (loculated, poorly defined, multiple, associated with fistula, draining feces) were successfully drained in 35 of 55 patients (63 percent). Success rates varied inversely with the number of complicating factors present. Apache II scores of 15 or higher were associated with decreased success rates. CONCLUSION Percutaneous abscess drainage is a highly successful technique for treatment of patients with intra-abdominal infection related to intestinal disease. Although several factors are associated with decreased success rates and multiple complicating factors combine to reduce success rates, no identifiable factor or combination of factors preclude the possibility of a successful outcome.
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Affiliation(s)
- A Bernini
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
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Luber S, Brady WJ, Young JS, Woods WA. Psoas abscess with sepsis mimicking traumatic hemorrhagic shock after a fall. J Emerg Med 1997; 15:623-7. [PMID: 9348048 DOI: 10.1016/s0736-4679(97)00123-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abscess of the psoas muscle is infrequently encountered. An infectious emergency of this type usually presents in a nonspecific manner and thus poses a significant diagnostic challenge to the emergency physician. Diagnosis and specific treatment are often delayed, which can lead to increased mortality. This case report presents a patient with altered mental status and hypotension after a fall, who was initially managed as a trauma victim. Emergency department evaluation initially focused on a traumatic etiology of the above abnormalities. Subsequent assessment determined that the patient's condition was due to an underlying psoas abscess with sepsis. Appropriate anatomy, clinical presentation, and management are discussed in hopes of increasing physician awareness of this uncommon infectious condition.
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Affiliation(s)
- S Luber
- Charlottesville-Albemarle Rescue Squad, and Department of Emergency Medicine, University of Virginia Health Sciences Center, USA
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Chung T, Hoffer FA, Lund DP. Transrectal drainage of deep pelvic abscesses in children using a combined transrectal sonographic and fluoroscopic guidance. Pediatr Radiol 1996; 26:874-8. [PMID: 8929300 DOI: 10.1007/bf03178041] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors review their experience with transrectal drainage of pelvic abscesses in seven children and adolescents (6-16 years old). Initial access was guided by transrectal ultrasound with an endovaginal transducer followed by fluoroscopy for placement of self-retaining catheters (8.5-10 F) using the Seldinger technique. All abscesses were successfully drained without complications. A transrectal catheter was well tolerated by most patients without spontaneous dislodgment. Catheters were removed after an average of 4 days (range 3-7 days). Transrectal drainage of pelvic abscess with transrectal sonographic and fluoroscopic guidance seems to be a safe and effective procedure in children.
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Affiliation(s)
- T Chung
- Department of Radiology, Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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McAuliffe W, Clarke G. The diagnosis and treatment of psoas abscess: a 12 year review. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1994; 64:413-7. [PMID: 8010904 DOI: 10.1111/j.1445-2197.1994.tb02241.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Over a 12 year period, 25 psoas abscesses occurring in 17 patients were managed at Royal Perth Hospital (900 bed hospital). Symptoms were present, on average, for 5 weeks prior to diagnosis, which was typically confirmed by computerized tomography. Fifty-nine per cent of cases were primary and percutaneous drainage effected a cure in 80% of all cases. Percutaneous drainage resulted in a non-significant trend towards shorter inpatient stay.
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Affiliation(s)
- W McAuliffe
- Department of Radiology, Royal Perth Hospital, Australia
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Levison MA. PERCUTANEOUS VERSUS OPEN OPERATIVE DRAINAGE OF INTRA-ABDOMINAL ABSCESSES. Infect Dis Clin North Am 1992. [DOI: 10.1016/s0891-5520(20)30461-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Adam EJ, Page JE. Intra-abdominal sepsis: the role of radiology. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1991; 5:587-609. [PMID: 1932831 DOI: 10.1016/0950-3528(91)90044-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A wide range of imaging tools is available for the investigation of abdominal sepsis. Plain films and barium studies alone are generally regarded as inadequate and most patients will require ultrasound, CT or nuclear medicine studies to locate the source of sepsis. The choice of imaging modality depends on several factors, most important of which are the clinical condition of the patient and the presence or absence of localizing signs and symptoms. Ultrasound has the advantage of being portable and is therefore probably the best initial imaging method for the critically ill patient. It should also be the first investigation in patients with signs and symptoms localizing to the right upper quadrant, renal areas, subphrenic spaces or pelvis. Transvaginal ultrasound is particularly useful in examining the pelvis. CT is the imaging modality of choice for the pancreas and retroperitoneum and in patients who are poor candidates for ultrasound or in whom visualization on ultrasound is inadequate. In patients with PUO or evidence of sepsis without localizing signs or symptoms, nuclear medicine studies in the form of 67Ga citrate or labelled white cell scans are useful to localize the septic focus, although in most cases CT or ultrasound will subsequently be required for detailed anatomical definition. Imaging techniques have an increasingly important role to play in the treatment of sepsis, and guided aspiration and drainage may be performed with a high degree of accuracy under ultrasound or CT guidance, eliminating the need for surgical intervention in many individuals.
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