• ascites
• complications
• drainage

• Digestive System Surgical Procedures
• Drainage
• Humans
• Postoperative Complications/diagnostic imaging
• Retrospective Studies

(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.

• Biopsy
• Cross-section interventional radiology
• Drainage
• Pancreas
• Pancreatic cancer
• Pancreatitis

• Colorectal cancer
• Embolization
• Gastric cancer
• Interventional radiology
• Malignancy
• Radiology

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.

• Abscess
• CT guided
• Fluid collections
• Interventional radiology
• Percutaneous drainage
• Pseudocyst

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.

• CT-guided drainage
• clinical outcome
• fluid collection
• liver resection
• technical outcome

To demonstrate options and alternative for drainage of inaccessible presacral abscess by the example of a rare clinical case of pyogenic spondylodiscitis, transsacraly drained under a combination of two interventional techniques – CT-guided bone biopsy and abscess drainage.

A 55-year-old patient with history of recurrent paravertebral abscesses previously treated with antibiotic therapy was referred to our institution experiencing lower back pain and weakness in both lower extremities. Computed tomography revealed pyogenic spondylodiscitis along with left facet joint destruction and presacral abscess located in ventral sacral surface. Due to inaccessible abscess location, it was decided to perform CT-guided percutaneous transsacral abscess drainage. An 8G bone marrow biopsy needle was used to penetrate the sacrum and create a path for drainage catheter placement. Using the Seldinger technique 8 Fr drainage catheter was inserted into abscess cavity.

Neither early nor late procedure-related complications occurred. Sixteen days after drainage procedure, the catheter was withdrawn as patient’s condition improved and the outflow of pus had reduced considerably.

Despite being rarely used, CT fluoroscopy-guided transsacral drainage approach is considered to be minimally invasive and in some cases the only viable option for drainage of pyogenic spondilodiscitis of the lumbosacral junction.

• Case report
• presacral abscess
• pyogenic spondylodiscitis
• transosseus drainage
• transsacral approach

Evaluate the feasibility, safety and accuracy of a CT-guided robotic assistance for percutaneous needle placement in the liver. Sixty-six fiducials were surgically inserted into the liver of ten swine and used as targets for needle insertions. All CT-scan acquisitions and robotically-assisted needle insertions were coordinated with breath motion using respiratory monitoring. Skin entry and target points were defined on planning CT-scan. Then, robotically-assisted insertions of 17G needles were performed either by experienced interventional radiologists or by a novice. Post-needle insertion CT-scans were acquired to assess accuracy (3D deviation, ie. distance from needle tip to predefined target) and safety. All needle insertions (43/43; median trajectory length = 83 mm (interquartile range [IQR] 72–105 mm) could be performed in one (n = 36) or two (n = 7) attempts (100% feasibility). Blinded evaluation showed an accuracy of 3.5 ± 1.3 mm. Accuracy did not differ between novice and experienced operators (3.7 ± 1.3 versus 3.4 ± 1.2 mm, P = 0.44). Neither trajectory angulation nor trajectory length significantly impacted accuracy. No complications were encountered. Needle insertion using the robotic device was shown feasible, safe and accurate in a swine liver model. Accuracy was influenced neither by the trajectory length nor by trajectory angulations nor by operator’s experience. A prospective human clinical trial is recruiting.

• Core biopsy
• fine-needle aspiration
• interventional radiology
• per-cutaneous drainage

• Cervical cancer
• Cystic tumors
• Image-guided percutaneous drainage
• Intraabdominal abscess
• Percutaneous drainage
• Tumor abscess

• Abscess/diagnostic imaging
• Abscess/mortality
• Abscess/therapy
• Adolescent
• Adult
• Aged
• Ascitic Fluid/diagnostic imaging
• Contrast Media
• Drainage/methods
• Exudates and Transudates/diagnostic imaging
• Female
• Humans
• Male
• Middle Aged
• Necrosis
• Neoplasms/mortality
• Neoplasms/pathology
• Neoplasms/surgery
• Pain Management
• Palliative Care
• Postoperative Complications/diagnostic imaging
• Postoperative Complications/mortality
• Postoperative Complications/therapy
• Radiography, Abdominal
• Radiography, Interventional
• Retrospective Studies
• Sepsis/diagnostic imaging
• Sepsis/mortality
• Sepsis/therapy

• T32 EB021955 NIBIB NIH HHS
• T32-EB021955 NIH HHS

• inaccessible abscess
• multiplane reconstruction
• percutaneous drainage
• transintestine

• Abdominal Abscess/surgery
• Abscess/surgery
• Adult
• Aged
• Drainage/methods
• Female
• Humans
• Male
• Middle Aged
• Pelvis/surgery
• Radiography, Interventional/methods
• Retrospective Studies
• Tomography, X-Ray Computed/methods
• Treatment Outcome

To analyze the efficacy of recombinant tissue plasminogen activator (r-TPA) injection in the evolution of percutaneous drainage of thick collections.

This was a single-center study involving the retrospective analysis of hospitalized patients undergoing percutaneous drainage of thick (superficial or intracavitary) fluid collections, followed by injection of a fibrinolytic agent (r-TPA) into the affected space.

A total of 53 percutaneous drainage procedures, with r-TPA injection, were performed in 51 patients. Abdominal and pelvic collections were the most common, being seen in 38 (73%) of the procedures; in 35 (66%), the etiology of the collection was attributed to postoperative complications. A total of 61 catheters were used in order to drain the 53 collections. Of those 61 catheters, 52 (85%) were large (12-16 Fr) and 9 (15%) were small (4-10 Fr). The mean r-TPA dose was 5.7 mg/collection per day, and the mean time from r-TPA injection to drain removal was 7.7 days. Percutaneous drainage in combination with r-TPA injection was successful in 96% of the cases. None of the patients showed coagulation changes during the study period.

The use of once-daily, low-dose r-TPA for up to three consecutive days, as an adjunct to percutaneous drainage of thick collections, with or without loculation, appears to be an effective technique.

• Abscess
• Drainage
• Fibrinolytic agents

• Dome
• hepatocellular carcinoma
• liver
• microwave ablation
• radiofrequency ablation

• celiac plexus block
• celiac plexus neurolysis
• image-guided approach
• interventional radiology
• pain management
• palliative care
• pancreatic cancer

• Abdominal abscess
• CT-guided
• Catheter drainage
• Pneumothorax
• Trocar

• Adult
• Aged
• Aged, 80 and over
• Catheterization/instrumentation
• Digestive System Diseases/diagnostic imaging
• Digestive System Diseases/therapy
• Drainage/instrumentation
• Female
• Fluoroscopy
• Humans
• Lung Diseases/diagnostic imaging
• Lung Diseases/therapy
• Male
• Middle Aged
• Radiation Dosage
• Radiography, Interventional/methods
• Retrospective Studies
• Surgical Instruments
• Tomography, X-Ray Computed/methods
• Urologic Diseases/diagnostic imaging
• Urologic Diseases/therapy

• Hepatic dome
• Hepatocellular carcinoma
• Percutaneous intervention
• Radiofrequency ablation

• Abdominal abscess
• Computed tomography
• Percutaneous drainage

• Abdominal Abscess/diagnostic imaging
• Abdominal Abscess/therapy
• Adult
• Aged
• Catheters
• Drainage/instrumentation
• Drainage/methods
• Female
• Humans
• Male
• Middle Aged
• Radiography, Interventional/methods
• Retrospective Studies
• Surgical Instruments
• Tomography, X-Ray Computed/methods

• CT-guided drainage
• deep pelvic abscesses
• presacral space

• Abscess
• CT
• Drainage
• Percutaneous
• Ultrasound

• Abdomen
• Biopsy
• Percutaneous

• Biopsy
• CT
• Drain placement
• Percutaneous
• Ultrasound

• Drainage/methods
• Humans
• Image-Guided Biopsy/methods
• Imaging, Three-Dimensional
• Radiography, Abdominal
• Radiography, Interventional
• Radiography, Thoracic
• Surgery, Computer-Assisted/methods
• Tomography, X-Ray Computed
• Ultrasonography, Interventional

Intra-abdominal and pelvic abscesses are common and result from various illnesses. Percutaneous drainage applies limitedly to well-localized abscesses with appropriate density while surgical drainage usually causes significant physiological disturbance. We herein illustrated an innovative choice “sump drainage with trocar puncture” for the management of intra-abdominal abscesses and compare it with conventional percutaneous and surgical drainage in terms of clinical outcomes and prognosis.

Medical records of a total of 75 patients with abscesses were retrospectively retrieved and scrutinized. Data consisted of demographics, abscesses characteristics and treatment outcomes including postoperative complication, duration of hospitalization, postoperative recurrence of abscesses, subsequent surgery, ultimate stoma creation and survival rate. All enrolled patients were divided into trocar group (n = 30), percutaneous group (n = 20) and surgical group (n = 25) according to the therapeutic modalities. One-way ANOVA and t-test with Welch’s correction were used in continuous variables, and Chi-squared test as well as Fisher’s exact test for categorical variables. The cumulative incidence of subsequent surgery and ultimate stoma creation was also indicated by the Kaplan–Meier method and compared by log-rank test.

The risk of ultimate stoma creation (p = 0.0069) and duration of postoperative hospitalization (p = 0.0077) were significantly decreased in trocar group compared with the surgical group. Patients receiving trocar puncture also tended to be less likely to have subsequent surgery (p = 0.097). Patients in trocar group displayed a lower rate of postoperative complication than the percutaneous (p = 0.0317) and surgical groups (p = 0.0175). As for Kaplan–Meier analysis, the cumulative incidence of ultimate stoma creation of the patients using sump drainage was also significantly different among three groups during follow-up period (p = 0.011).

This novel technique “sump drainage by trocar puncture” could produce better clinical outcomes and prognosis than conventional percutaneous drainage and surgical intervention. It might become an optimal choice in the management of intra-abdominal abscesses in the future.

• Crohn disease
• computed tomography
• pancreatitis
• percutaneous abscess drainage
• ultrasound

• Computed tomography
• Percutaneous drainage
• Post-operative abscess
• Surgery
• Ultrasonography

Percutaneous access to the surgical bed after pancreaticoduodenectomy can be a challenge, due to the post-operative anatomy alteration. However, immediate complications, such as surgical bed abscess or suspected tumor recurrence, are often best accessed percutaneously, as open surgical or endoscopic approaches are often difficult, if not impossible. We, hereby, describe a safe approach that is highly replicable, in accessing the surgical bed for percutaneous intervention, following pancreaticoduodenectomy.

• Pancreaticoduodenectomy
• Percutaneous
• Retroperitoneal

• Abdominal Abscess/complications
• Abdominal Abscess/surgery
• Colonoscopy
• Constriction, Pathologic/etiology
• Drainage
• Female
• Humans
• Middle Aged
• Sigmoid Diseases/etiology