IMAGING PROCEDURE
Percutaneous Intraabdominal/
Pelvic Abscess Drainage
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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