Intraabdominal collections (IACs) are common following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Inflammatory biomarkers and nutritional index (NI) may predict IACs. Management of IACs with image guided percutaneous drainage (IGPD) is an alternative to laparotomy.

To identify factors that predict IACs following CRS and HIPEC and to review outcomes following IGPD.

A retrospective review of prospectively collected data from a national referral centre including patients undergoing CRS and HIPEC who developed IACs treated with IGPD, between January 2018 and March 2022. Propensity score matched cases were compared to evaluate the prediction of IACs. The outcomes of IGPD were reviewed.

Intraabdominal collections developed in 106 (8.0 %) of 1313 patients and 101/106 underwent IGPD, under Ultrasound or CT guidance. Laparotomy was required in 5/106. In those undergoing IGPD, pre- and postoperative CRP and neutrophils were significantly elevated while pre- and postoperative albumin and NI were significantly lower than propensity score matched controls. The postoperative CRP and neutrophil count, and pre and postoperative albumin and mGPS were identified as independent predictors in multivariable analysis. IGPD improved clinical condition in 94 %. In 15/106(14.8 %) the aetiology of the IAC was anastomotic leak with left subphrenic collections the most common (24/101, 24 %). There were 4 major complications, 2 perforations of bladder during IGPD insertion and 2 post drain removal bleeds.

Intraabdominal collections following CRS and HIPEC can be predicted by inflammatory markers and nutritional index. Prompt use of IGPD results in good outcomes avoiding the need for laparotomy.

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.

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.

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.

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.

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.

Intestinal ultrasound is increasingly used for primary diagnosis, detection of complications and monitoring of patients with Crohn's disease and ulcerative colitis. Standardization of reporting is relevant to ensure quality of the methodology and to improve communication between different specialties. The current manuscript describes the features required for optimized reporting of intestinal ultrasound findings in inflammatory bowel disease (IBD).

An expert consensus panel of gastroenterologists, radiologists, pathologists, paediatric gastroenterologists and surgeons conducted a systematic literature search. In a Delphi- process members of the Kompetenznetz Darmerkrankungen in collaboration with members of the German Society for Radiology (DRG) voted on relevant criteria for reporting of findings in intestinal ultrasound. Based on the voting results statements were agreed by expert consensus.

Clinically relevant aspects of intestinal ultrasound (IUS) findings have been defined to optimize reporting and to standardize terminology. Minimal requirements for standardized reporting are suggested. The statements focus on description of disease activity as well as on complications of IBD. Attributes of intestinal inflammation are described and illustrated by exemplary images.

The current manuscript provides practical recommendations on how to standardize documentation and reporting from intestinal ultrasound findings in patients with IBD.

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.

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.

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.

This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD.

Management of the acute anastomotic leak is complex and patient-specific. Clinically stable patients often benefit from a nonoperative approach utilizing antibiotics with or without percutaneous drainage. Clinically unstable patients or nonresponders to conservative management require operative intervention. Surgical management is dictated by the degree of contamination and inflammation but includes drainage with proximal diversion, anastomotic resection with end-stoma creation, or reanastomosis with proximal diversion. Newer therapies, including colorectal stenting, vacuum-assisted rectal drainage, and endoscopic clipping, have also been described.

Intra-abdominal abscess (IAA) post-appendicectomy occurs in 1.4-4.4% of cases. Non-operative management of small (<4 cm) post-appendicectomy IAA in children is well established, but minimal evidence exists in adults. Percutaneous catheter drainage is considered standard treatment for IAA, yet outcome data for post-appendicectomy IAA are sparse. The aims of this study were to assess the effectiveness of non-operative management of small (<4 cm diameter) IAA and the outcomes of percutaneous drainage for larger (>4 cm) IAA post-appendicectomy.

A retrospective case note review of a series of patients with a post-appendicectomy IAA between 2006 and 2017 was conducted. IAAs were treated selectively; small (<4 cm) IAAs were managed non-operatively and larger IAAs were managed with percutaneous drainage .

A total of 4901 patients had an appendicectomy. Forty-two (0.9%) developed a post-operative IAA. Sixteen (38%) had a percutaneous drainage and 26 (62%) had non-operative management. The percutaneous drainage group had a higher proportion of complicated appendicitis (75%) compared to the non-operative group (42%, P = 0.04). The percutaneous drainage group had a significantly higher leucocytosis (P = 0.01) and C-reactive protein (P = 0.02). All patients managed non-operatively resolved without the need for invasive procedures. In the percutaneous drainage group, six had aspiration alone, nine had a percutaneous drain and one was abandoned. Three required repeat percutaneous drainage and four (25%) required operative drainage. Seven patients (34%) of the percutaneous drainage group had grade II or III complications.

This case series study provides support that small (<4 cm) IAA post-appendicectomy can be safely and effectively managed non-operatively.

To assess the feasibility of paired catheter drainage for management of complex abdominal abscesses.

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.

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.

Percutaneous paired catheter drainage is a feasible technique for the treatment of both complex intraabdominal abscesses and abscesses unresponsive to single catheter drainage.

Abdominal abscesses are one of the frequent and dangerous postoperative complication. They occur as a result of failure of seams esophagojejunal anastomosis after gastrectomy (17%), perforation of gastric and duodenal ulcers (26.8%), splenectomy (25.4%), failure of biliodigestive anastomoses (23.8%), inadequate drainage of the subphrenic space (22.2%), acute pancreatitis (14%). Left-sided subphrenic abscesses are the most common of them.

We present a patient with the left-sided subphrenic abscess, formed as a result of insolvency of the esophagojejunal anastomosis after gastrectomy and splenectomy, which underwent percutaneous drainage under the control of ultrasound and X-ray. Sanitation of the abscess cavity and the introduction of fibrin glue into it made it possible to close the fistula and heal the patient.

The described case shows that the rehabilitation of the abscess and the injection of fibrin glue into it, made it possible to avoid surgery, eliminate the abscess and close the connection with the esophagojejunal anastomosis in a short time.

Percutaneous drainage under the control of ultrasound made it possible to avoid surgery and heal the patient with the left-sided subphrenic abscess in a short time. Fistula treatment with fibrin glue is not only effective, but is also less risky than surgery.

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.

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.

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.

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.

Abdominal abscess that result from bowel injury may require treatment with percutaneous drainage. In some cases, an abscess-associated fistula develops between the injured bowel and the drainage catheter. Fistulas that fail to resolve may require surgery; however, fibrin glue therapy (FGT) may be a suitable alternative.

We retrospectively identified patients undergoing FGT for an abscess-associated enteric fistula between 2004 and 2015. Success was defined as closure of the fistula tract without need for additional intervention. A multivariable logistic regression analysis was utilized to identify factors associated with success.

We identified 34 patients with a median age of 54 (23-87) years and 24 (71 %) males. FGT was successful in 23 (67 %) patients. On multivariate analysis, a tract width less than 5 mm (OR 19.2, 95 % CI 1.7-214.5) and removal of the drain (OR 13.8, 95 % CI 1.2-157.6) predicted FGT success. The time from initial FGT to resolution was significantly decreased for the patients who were successfully treated compared to those who failed 24 (14-38) days vs. 99 (71-175) days, respectively (p < 0.001).

Fibrin glue therapy for abscess-associated enteric fistula results in successful and accelerated healing in the majority of cases. Factors associated with successful fibrin glue therapy were identified.

Laparoscopic cholecystectomy is a commonly performed surgical procedure for the treatment of symptomatic cholelithiasis. As with all surgical procedures, it carries risk, with the most commonly reported complications including infection, bile leak and bleeding. One unusual complication is subcapsular liver haematoma, the diagnosis presented here. This is a rare occurrence; only a small number of cases have been reported in the literature and as yet no conclusive cause or management plan has been found. Iatrogenic liver trauma, the use of oral and intravenous non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants have all been named as possible contributing factors. Particularly, the use of ketorolac has been associated with four reported cases of subcapsular haematoma following laparoscopic cholecystectomy. The case reported here refutes that hypothesis, as neither NSAIDs nor anticoagulants were used during the treatment of this patient.

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.

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.

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).

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.

The aim of this study was to evaluate the impact of positive bacterial cultures of the drainage fluid (D-cultures) during the early postoperative period on the incidence of intra-abdominal abscess formation following gastrectomy.

From January 2012 to June 2013, we prospectively performed D-cultures on postoperative day (POD) 1 in consecutive gastric cancer patients who underwent gastrectomy. The univariate and multivariate analyses were performed to identify the risk factors for intra-abdominal abscess formation without anastomotic leakage.

The rate of positive D-cultures was 6.4 % on POD 1. According to a univariate analysis, the use of combined organ resection (P = 0.011), the drain amylase level on POD 1 (P = 0.016) and the D-culture status on POD 1 (P = 0.004) were found to be significantly associated with the incidence of intra-abdominal abscesses. A multivariate analysis demonstrated that D-culture positivity on POD 1 was the only independent predictor of intra-abdominal abscess formation (P = 0.011).

The present study demonstrated that bacterial culture positivity of drainage fluid during the early postoperative period has a significant impact on the development of intra-abdominal abscesses after gastrectomy.