Ultrasound guided percutaneous drainage of intra-abdominal abscesses and fluid collections

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 . To evaluate the efficacy of US-guided percutaneous drainage in treating intra-abdominal abscesses and fluid collections. 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 and aseptic technique, needle access obtained before placing the catheter .Peritoneal Dialyses catheter was used in our study. 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%] and 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 and 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%] and 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 and 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%] 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