Imaging percutaneous intrabdominal pelvic abcess drainage

IMAGING PROCEDURE

Percutaneous Intraabdominal/
Pelvic Abscess Drainage

Objective

In cases of suspected intraabdominal abscess:

•   Diagnostic aspiration of intraabdominal fluid collections for microbiologic diagnosis

•   Drainage of postoperative/spontaneous abscesses

•   Drainage of liver/visceral abscesses

•   Prevent impending rupture of visceral abscesses.

Patient Preprocedure Preparation

•   Blood prothrombin time

•   Antibiotic cover if required

•   Fasting for 6 hours

•   Surgical cleaning and draping of the site of drainage.

Position

Supine and related to location of abscess.

Anesthesia

•   IV sedation with diazepam

•   Local infiltration analgesia with 1% xylocaine 10 ml

•   General anesthesia may be required for infants and uncooperative children.

Instruments

•   18 G, 20 cm long needle with stilet (Fig. 22.1)

•   0.035" or 0.038" diameter, 100 cm long J-shaped guidewire

•   Sterile surgical blades

•   Graded teflon dilators 7F-12F

•   Drainage catheter 8F-12F. Pigtail with multiple holes; or Malecot catheter/Sump drainage catheter with needle-introducer

•   Suture and needle for fixation of catheter

•   Adhesive tape

•   Connector (Fig. 22.2)

•   3-way stopcock (Fig. 22.3)

•   Negative suction bag (Romovac)

•   Biopsy needle (Fig. 22.4).

Procedure

   1.  Patient positioned according to location of abscess, such that puncture site is easily accessible.

   2.  Sonographic or CT guidance.

   3.  Puncture site chosen under sonographic/CT guidance with 18 G needle.

   4.  Follow needle till its tip is well inside the abscess cavity. Remove stilet of needle.

   5.  Aspirate 2-5 ml of fluid; store in sterile vial for microbiologic analysis.

   6.  Pass guidewire through needle. Check position of guidewire within abscess cavity.

   7.  Stab incision along needle tract.

   8.  Remove cannula of needle.

   9.  Dilate tract to one size above catheter size.

10.  Place catheter in abscess cavity over guidewire.

11.  Remove guidewire.

12.  Connect catheter to negative suction collection system.

13.  Suture catheter and skin wound.

14.  Secure catheter to skin with adhesive tape.

Postprocedure

1.  Flush abscess cavity with antibiotic saline periodically.

2.  Remove catheter when drainage stops completely.

Alternative Technique

1.  This technique is suitable for larger fluid collections, and requires an experienced operator.

2.  Local analgesia.

3.  Stab incision at site.

4.  Use needle/introducer/catheter assembly, e.g. pigtail catheter/Malecot catheter/Sump catheter.

5.  Insert assembly through stab incision, and direct toward abscess cavity.

6.  When needle tip is well inside the cavity, withdraw needle-introducer, leaving catheter in cavity.

7.  Aspirate some fluid for bacteriologic diagnosis.

8.  Connect catheter to negative suction system and follow remaining steps as above.

Complications

Hemorrhage.

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