Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND :
Percutaneous image-guided drainage is the first-line treatment for infected or symptomatic fluid collections in the abdomen and pelvis, in the absence of indications for immediate surgery and considered potentially a life saving therapeutic surgical procedure in high risk patients .
OBJECTIVE:
To evaluate the efficacy of US-guided percutaneous drainage in treating intra-abdominal abscesses and fluid collections
PATIENTS & METHOD :
Patients with intra-abdominal collections underwent percutaneous drainage under ultrasound (US) guide were studied prospectively in the Gastro-enterology and hepatology hospital in baghdad from April 2008-Sept 2009. The procedure done under local anesthesia & aseptic technique, needle access obtained before placing the catheter .Peritoneal Dialyses catheter was used in our study.
RESULTS :
There were 43 patients (29 females and 14 males ), Age ranging 8-67 years. The collections diagnosed basically on US in 33 patients ( 76.7% ) & US and CT-scanning needed in 10 (23.3%). These collections were post-operative in 36 patients (83.7%) and primary (spontaneous) in 7 (16.3%)The post-operative cases were as follow:18 patients (50 % ) operated on for gall bladder diseases, 6 (16.7 %) for abdominal trauma ,4 ( 11% ) for acute abdomen , 4 ( 11% )for Hydatid cyst, 2 (5.6 %) colonic surgery and one patient (2.8 %) operated on for acute appendicitis and one (2.8%) after ERCP. Twenty three (53.5 %) of the collections were single & 20 (46.5%) were multiple. The single collections were located as: Right Hypochondrial(Right subphrenic,Subhepatic and Hepatic) in 15 patients (65.2 %), Epigastric in 4(17.4 %),2 of them were pancreatic, Pelvic in 3 (13 % ) , and paracolic in one patient ( 4.4 % ). Six patients(14 %) have hepatic collections, 4 of which were following Hydatid Cyst Surgery, the remainder were Pyogenic hepatic abscesses. Material drained was Bile in 24 patients ( 56 %),Pus in 17(39.5 %) & blood and urine in one patient (2.25 %) for both, Fourteen patients (32.6%) underwent more than single drainage procedure, nine of them (64.3 % ) twice , three (21.4 %) three times& two (14.3% )more than 3 re-interventions.
The operations has been avoided in 26 patients (60.5 %) but was not avoidable in 17 ( 39.5% ), because of the ultimate need of the condition for operation in 15 patients (88 % )and failure of drainage in 2 patients ( 4.7 %)
CONCLUSION:
US guided drainage is an efficacious therapy for intra-abdominal collections and have become the treatment of choice for a wide variety of collections. It helps to obviate or delay a major surgery.