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Axial CT image obtained in a 13-year-old male patient shows an appendiceal abscess (solid arrows ) surrounded by bowel (open arrows), a finding that precluded drainage with a percutaneous approach. Because the abscess was also located too far cephalad to allow use of a transrectal approach (compare with Fig 5), surgery was performed.
Source publication
Percutaneous imaging-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. The technology and expertise needed to perform percutaneous abscess drainage are widely available and readily adapted for use in the pediatric population. Cath...
Contexts in source publication
Context 1
... practical purposes, the absence of a safe percuta- neous path is the only factor that prohibits percu- taneous abscess drainage, since in most instances coagulopathy can be corrected to allow drainage. The presence of bowel near the abscess may pre- clude percutaneous abscess drainage (Fig 1). Ab- scesses located near or between bowel loops are not amenable to percutaneous catheter drainage and may require surgery if the patient experiences symptoms of peritonitis. ...
Context 2
... a fistula is suspected, a sinogram may be useful for diagnosis and localization. If the sus- pected fistula is in the bowel, CT may be per- formed with oral contrast material to confirm the diagnosis (Fig 10). Prolonged drainage may allow a fistula to close, but in some cases surgery may be necessary. ...
Context 3
... pa- tients with a high-output enteral fistula, prolonged parenteral nutrition and exclusion of oral nutri- tion may be necessary. Abscess recurrence after successful drainage is rare; it is found in less than 5% of patients (Fig 11). In some patients, re- peated percutaneous drainage may be successful, but other patients may eventually require surgery. ...
Context 4
... conditions might cause tran- sient leukocytosis and fever, symptoms that could lead to the misinterpretation of CT findings as abscesses. However, minimal fluid drainage and little change in the appearance of the lesion on images should prompt consideration of other di- agnoses, such as low-density tumors (Fig 12). Tumors, it must be remembered, also may be- come infected, and percutaneous abscess drain- age is indicated also for treatment of tumor ab- scesses. ...
Context 5
... general, acute collections are not infected. However, if superinfection of a peripancreatic fluid collection is suspected, per- cutaneous imaging-guided needle aspiration may be performed to obtain a specimen for culture (Fig 13). By definition, a pancreatic abscess is any peripancreatic fluid collection that is infected (26). ...
Context 6
... definition, a pancreatic abscess is any peripancreatic fluid collection that is infected (26). In infected fluid collections, percutaneous drainage is indicated (Fig 14). Alternatively, the abscess may be surgically drained. ...
Citations
... Image-guided percutaneous abscess drainage (IPAD) is a minimally invasive technique that helps manage infectious complications by removing symptomatic or infected fluid collections. IPAD is the first-line treatment option for abdominal abscesses in pediatric patients in cases with no other concurrent indication for immediate surgery [1,2]. IPAD was first introduced in the late 1970s for adult patients but has since been adapted for children and is now frequently used in pediatrics [2][3][4]. ...
... IPAD is the first-line treatment option for abdominal abscesses in pediatric patients in cases with no other concurrent indication for immediate surgery [1,2]. IPAD was first introduced in the late 1970s for adult patients but has since been adapted for children and is now frequently used in pediatrics [2][3][4]. The most common IPAD indication in children is an appendicular abscess [5]. ...
... In smaller abscesses, diagnostic aspiration of no more than 5 mL of fluid is recommended to avoid collapsing the abscess cavity, thus rendering catheter insertion and end-loop formation difficult [35]. If no aspirate can be drawn despite an optimal needle tip position and up-sizing the needle to an 18 gauge, then performing a biopsy or placing a test drainage catheter are an option [2]. Especially in younger children, diagnostic drainage or puncture and drainage catheter placement should be performed under general anesthesia to reduce the pain burden, preferably in a single session to minimize anesthesia-related complications. ...
Image-guided percutaneous abscess drainage (IPAD) is an effective, minimally invasive technique to manage infected abdominal fluid collections in children. It is the treatment of choice in cases where surgery is not immediately required due to another coexisting indication. The skills and equipment needed for this procedure are widely available. IPAD is typically guided by ultrasound, fluoroscopy, computed tomography, or a combination thereof. Abscesses in hard-to-reach locations can be drained by intercostal, transhepatic, transgluteal, transrectal, or transvaginal approaches. Pediatric IPAD has a success rate of over 80% and a low complication rate.
... Thereafter, patients would be treated with a combination of antibiotics. If clinical resolution failed after medical therapy, surgical drainage would be performed using either a percutaneous or laparoscopic approach based on the patient's clinical condition (10,11). ...
... Among the remaining 499 patients, 13 children (2.6%) developed an abdominal, postappendectomy abscess as a postoperative complication. Of these 13, there were 4 girls (30.8%) and 9 boys (69.2%) aged between 2 and 17 years (median age,11 years; IQR, [9][10][11][12][13][14] and weighing between 14.1 and 72.3 kilograms (median weight, 31.2; IQR, 27.1-51.1). ...
Background:
Appendectomy is the most common surgical emergency that occurs in childhood and is typically performed to treat appendicitis. Nonetheless, postoperative complications remain common and the development of an intra-abdominal abscess is not an uncommon complication.
Materials and Methods:
In this retrospective study, patient records of individuals under 18 years of age treated at our Pediatric Surgery Department for acute appendicitis and developed a post-operative abscess were examined. Examined data included demographic information and outcomes with particular attention to time at diagnosis of abscess after surgery, symptoms progression, biomarkers changes, abscess’ size, hospital length of stay, and treatment.
Results:
Overall, thirteen children developed an abdominal post-appendectomy abscess as post-operative complication. Most patients had large-sized or multiple abscesses. The treatment was primarily performed with antibiotic therapy in the majority of cases, even though four patients required secondary surgical intervention. The success rate of the antibiotic treatment was about 70%, while that of the secondary surgical interventions was 100%. Median length of stay for patients experiencing post-operative complications was 7 days.
Conclusions:
To improve the treatment of post-appendectomy abscesses in pediatric patients, implementing recent protocols for small and medium-sized abscesses should be considered. In addition, according to our experience, non-operative management can be initially attempted for large abscesses, followed by surgical drainage if no improvement is noted within 24–48 hours.
... Indeed, generally, transection of the small bowel with a small (19 -22 gauge) needle is safe. Contrarily, transection of the colon should be avoided, because of the colonic flora, that in drainage abscess might cause infection of the fluid collection [36]. ...
The aim of the article is to introduce a new term in post-procedural events related to the procedure itself. All the Societies and Councils report these events as complications and they are divided in mild, moderate and severe or immediate and delayed.
On the other hand the term error is known as the application of a wrong plan, or strategy to achieve a goal.
For the first time, we are trying to introduce the term “consequence”; assuming that the procedure is the only available and the best fit to clinical indication, a consequence should be seen as an expected and unavoidable occurrence of an “adverse event” despite correct technical execution.
... Contrarily, transection of the colon should be avoided, because of the colonic ora, that in drainage abscess might cause infection of the uid collection. [37] Appropriate pre-procedural planning and real-time imaging (i.e. US) can reduce the incidence of perforation. ...
The aim of the article is to introduce a new term in post-procedural events related to the procedure itself. All the Societies and Councils report these events as complications and they are divided in mild, moderate and severe or immediate and delayed.
On the other hand the term error is known as the application of a wrong plan, or strategy to achieve a goal.
For the first time, we are trying to introduce the term “consequence”; assuming that the procedure is the only available and the best fit to clinical indication, a consequence should be seen as an expected and unavoidable occurrence of an "adverse event" despite correct technical execution.
... Despite the variety of imaging modalities available for detecting fluid collections, image-guided drainage placement is mostly performed under sonographic or CT guidance. While sonography is often utilized as guidance for fluid collections that are located superficially [5] and is the modality of choice for pediatric interventions [6], CT guidance is used mostly for accessing fluid collections deeper within the thorax, abdomen or pelvis, especially when using a transgluteal approach [3,7,8]. Even though percutaneous abscess drainage (PAD) is performed routinely nowadays, there is no clear recommendation as to whether or not PAD should be flushed with diluted contrast medium (CM) after CT-guided placement to gain additional information about the origin or possible co-factors of the fluid collection. ...
The aim was to evaluate the additive clinical value of an additional post-procedural control-scan after CT-guided percutaneous abscess drainage (PAD) placement with contrast medium (CM) via the newly placed drain. All CT-guided PADs during a 33-month period were retrospectively analyzed. We analyzed two subgroups, containing patients with and without surgery before intervention. Additionally, radiological records were reevaluated, concerning severe inflammatory response syndrome (SIRS) during the intervention. A total of 499 drainages were placed under CT-guidance in 352 patients. A total of 197 drainages were flushed with CM directly after the intervention, and 51 (26%) showed an additional significant finding. An immediate change of therapy was found in 19 cases (9%). The subgroup that underwent surgery (120 CM-drainages; 32 (27%) additional findings; 13 (11%) immediate changes of therapy) showed no statistically significant difference compared to the subgroup without surgery (77 CM-drainages; 19 (25%) additional findings; 5 (6%) immediate changes of therapy). SIRS occurred in 2 of the 197 flushed drainages (1%) after CM application. An additional scan with CM injection via the newly placed drain revealed clinically significant additional information in almost 26% of the drainages reviewed in this study. In 9% of the cases this information led to an immediate change of therapy. Risks for SIRS are low.
... The absence of a safe percutaneous path is the factor that prohibits percutaneous abscess drainage. The presence of bowel or gastrointestinal organ near the abscess may 13 contraindicate percutaneous abscess drainage. Infection after percutaneous drainage is divided into two, namely the time of insertion of the first drainage catheter and the time of repeated drainage catheter placement. ...
Objective: This case report will discuss the experience of using percutaneous drainage as an alternative of open surgery in pararenal abscess therapy. Case(s) Presentation: 61 years old woman complained of left flank pain 6 months before with septic condition. Physical examination revealed tenderness and mass in the left flank region with leukocytosis. Abdominal Computed Tomography (CT) Scan results showed a left lower pole pararenal abscess, severe hydropyonephrosis and ureteropelvic junction stones. Percutaneous abscess drainage and percutaneous nephrostomy was performed with an 18Fr troicart using ultrasound guidance. Discussion: The pus culture showed Escherichia coli bacteria. After three days of operation and intravenous antibiotics, the patient experienced clinical improvement. Outpatient follow-up showed decreased drain production from percutaneous abscess drainage and clear yellow liquid production from percutaneous. Percutaneous nephrolithotomy was performed for the management of stone evacuation. After going through the whole procedure, there is clinical improvement of patient. Conclusion: Percutaneous drainage is an alternative option in the management of perirenal abscesses. Compared to open surgical drainage, the percutaneous technique provides a minimally invasive process, shorter length of stay and more effective costs. This procedure has also shown good clinical improvement in patients. Keywords: Minimal invasive, pararenal abscess, percutaneous drainage.
... Although initially conceived and designed for adults, PIGD has become the standard of care for many conditions in children and a mainstay of pediatric interventional radiology (IR) practice. [1][2][3] As in adults, fluid collections in nearly every organ system or cavity have been successfully treated with this approach. [4][5][6][7][8][9][10][11] PIGD markedly reduces morbidity and mortality compared with open surgical drainage by offering a definitive minimally invasive therapeutic approach or promoting a more accessible, cleaner, and technically less challenging subsequent surgical procedure. ...
... [4][5][6][7][8][9][10][11] PIGD markedly reduces morbidity and mortality compared with open surgical drainage by offering a definitive minimally invasive therapeutic approach or promoting a more accessible, cleaner, and technically less challenging subsequent surgical procedure. 1,2,8,9,12 Additionally, pediatric IR interventions have been shown to improve patient comfort, promote rapid recovery, and decrease hospital stay and costs. [4][5][6]9,[11][12][13] While similar principles and techniques apply to both children and adults, several significant differences should be considered. ...
... Drainage could be definitive or adjunctive therapy to facilitate further management. 1,17 As with all interventions, the potential contraindications, complications, and risks, as well as the potential benefits of alternative surgical or medical therapies, should be considered and discussed with the patient's parents or guardians. 1,3,17,19 For example, open surgery may be a better approach for complex abscesses that include multiple loculations or septations, interloop collections, or those associated with an active enteric fistulous communication. ...
While initially conceived and designed for adults, percutaneous image-guided drainage of abdominal pelvic and fluid collections has revolutionized the management of several pediatric pathologies. Interventional radiology procedures markedly reduce morbidity and mortality by offering a definitive minimally invasive approach or allowing a cleaner and less challenging subsequent open approach. These procedures are associated with improved patient comfort and rapid recovery. While similar techniques apply to children and adults, successful adaptation of image-guided interventional techniques in children requires consideration of several critical differences. This review aims to discuss the indications, contraindications, and technical aspects of percutaneous image-guided drainage of abdominal and pelvic fluid collections in children.
... Interventional radiology-placed drains are often the first-line treatment for infected or symptomatic fluid collections in the absence of indications for immediate surgery. If infected collections are complex, adjuvant intracavitary thrombolytic therapy can be used to facilitate drainage[37]. ...
Purpose of Review
Pediatric interventional radiology (IR) is a growing subspecialty. Here, we review the current role of IR in children with cancer, which uses imaging such as ultrasound, fluoroscopy, and computed tomography to perform minimally invasive procedures. These include biopsy, needle localization, central venous access, thermal ablation, transarterial chemoembolization, transarterial radioembolization with yttrium-90, non-tunneled/tunneled drainage catheter placement, and lymphatic interventions.
Recent Findings
Although locoregional therapies for the treatment of cancer in adults are common, they are less common in children, perhaps due to the relative rarity of cancer in children, their typically better performance status, and paucity of comorbidities. Preliminary results from small-scale studies for ablation, transarterial chemoembolization, and transarterial radioembolization with yttrium-90 used in the front-line armamentarium of curative therapy are encouraging.
Summary
Pediatric IR offers an array of minimally invasive procedures intended to diagnose and treat pediatric cancer patients. However, more research is required to determine the efficacy of locoregional therapy in children and to define the clinical scenarios where benefit is likely to be optimized.
... Preceding the catheter insertion, placement of a guiding needle into the collection can provide an external reference for accurate placement of the catheter in tandem, so called the "tandem" trocar technique. The trocar technique allows the operator to quickly insert the catheter; however, this technique does not allow catheter repositioning after the first pass [70][71][72]. An additional modification to the trocar technique, the curved trocar technique, involves bending the metal trocar to allow intermittent visualization and redirection/adjustment of the catheter under CT fluoroscopy prior to being positioned within the collection [73]. ...
... Generally, pancreatic collections require larger catheters for drainage due to viscous contents, possibly related to effects of amylase and lipase on fat necrosis. Small catheters (8)(9)(10)(11)(12) can be upsized to larger catheters (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) if solid necrotic components are present [61,70]. Multiple catheters may be required for adequate drainage of complex collections. ...
Percutaneous pancreatic interventions performed by abdominal radiologists play important diagnostic and therapeutic roles in the management of a wide range of pancreatic pathology. While often performed with endoscopy, pancreatic mass biopsy obtained via a percutaneous approach may serve as the only feasible option for diagnosis in patients with post-surgical anatomy, severe cardiopulmonary conditions, or prior non-diagnostic endoscopic attempts. Biopsy of pancreatic transplants are commonly performed percutaneously due to inaccessible location of the allograft by endoscopy, usually in the right lower quadrant or pelvis. Percutaneous drainage of collections in acute pancreatitis is primarily indicated for infection with clinical deterioration and may be performed alone or in combination with endoscopic drainage. Post-surgical pancreatic collections related to pancreatic duct fistula or leak also often warrant therapeutic percutaneous drainage. Knowledge of appropriate indications, strategies of approach, technique, and complications associated with these procedures is critical for a successful clinical practice.
... Cerrahi drenaj işlemi ile karşılaştırıldığında perkütan apse direnajının mortalite ve morbiditesi az, hastanede kalış süresi kısa ve daha ucuzdur. İşlemin başarı oranı %80-100' dür (8,9,22). ...
... Portal ven trombozu olan hastalar ile neonatal dönemde umblikal kateterizasyana sekonder gelişebilir. Tümör nekrozu olan hastalarda inatçı abseler gelişebilir (3,8,9,22,23). ...
... Özellikle Güney Afrika, Asya' da amibik karaciğer apsesi daha sık görülmektedir ve daha çok konservatif olarak tedavi edilir. Perkütan drenaj antibiyotik tedavisine yetersiz cevap vermesi ya da rüptür şüphesi gelişmesi durumunda yapılır (5,8). ...
Hepatoloji kitabında karaciğerin anatomisi, fizyolojisi, erişkin karaciğer hastalıkları, karaciğer nakli, pediyatrik karaciğer hastalıkları ve yaklaşım konularını tüm yönleriyle okuyucuya anlatmayı, güncel gelişmeler eşliğinde yeni eklenen tüm tanı ve tedavi metodlarını sunmayı amaçladık. Hangi hastalıklarda hangi tanı ve tedavi algoritmasının gerektiği, fizyolojik süreçlerde karaciğer, yine güncel konulardan diyet ve fitoterapinin karaciğere etkisi ilgili bölümlerde anlatıldı.Karaciğer günümüzde tıp dünyasındaki birçok gelişmeye rağmen keşfedilebilirliğini korumakta, karaciğer hastalıklarıyla ilgili yine günümüzde farklı tedavi metodları araştırılmaktadır. Endikasyonu olan hastalarda karaciğer nakli tüm dünyada en geçerli tedavi metodu olarak yerini korumakla birlikte, gelecekte gerek kök hücre ve moleküler düzeyde tedavilerin gerek medikal tedavi metodlarının geli-şimi belki de cerrahi müdahaleyi çok daha az tercih edilen bir seçenek haline getirecektir. Karaciğeri anlamak için anatomi, fizyoloji ve histolojisi, embriyolojik gelişimi, rol alan genetik ve moleküler sis-temler, hastalıkların patofizyolojisi ve gelecek perspektiflerini değerlendirmek, anlamak ve yayınlanan güncel kaynakları sürekli araştırmak gereklidir. Hepatoloji kitabının da araştırılması ve referans olarak alınması gereken kaynaklar arasında yerini alacağına inanıyoruz.Kitabın önemli özelliklerinden birisi gerek cerrahi ve girişimsel tedavi yöntemleri gerekse medikal tedavi algoritmalarını okuyucuya sunması ve ilgili branş hekimine klinik olarak yol göstermesidir. Yine, uygulanan medikal ve cerrahi tedaviler ile birlikte, bunların yan etki ve komplikasyonlarıyla mücadele edilebilmesi için rehber niteliğinde hazırlanmış kitabımızda, karaciğer naklinin, hepatoloji-nin tüm yönleriyle birçok bölümde bütünleştiğini, tedavi metodlarının kimi bölümlerde özet önerile-rini kimi bölümlerde ise algoritma şeklinde ayrıntılı sunumlarını bulacaksınız. Karaciğere ait konular oldukça ayrıntılandırılmış, farklı bölümlerde kısmen benzer ancak farklı referanslar yoluyla edinilmiş bilgilerin bölümlere entegrasyonu sağlanarak okuyucunun konuyu daha iyi öğrenebilmesi hedeflen-miştir. Ayrıca pediatrik ve yetişkin karaciğer hastalıklarında edineceğiniz benzer bilgilerin farklı yaş gruplarındaki değişkenliği hem konuya bakış açınızı pekiştirecek hem de farklılıkları görmenizi sağ-layacaktır. Okuyucu, normal bir karaciğer fonksiyonu ile ilgili tüm bilgilere erişebilmenin yanında gebelik gibi fizyolojik değişim süreçleriyle ilgili de yine ayrıntılı bir bilgi edinme şansı bulacaktadır. Kitabın diğer özelliği, konuların teorik ve klinik özelliklerine farklı branşlar tarafından yapılan yak-laşımlar ile bakış açılarının zenginleştirilmeye çalışılmasıdır. Konular cerrahi, gastroenteroloji, radyo-loji ya da enfeksiyon hastalıklarına ait bakış açılarıyla harmanlanmaya çalışılmış, farklı branşlardan okuyucuların kitaptan daha spesifik olarak yararlanması sağlanmıştır. Karaciğere faydalı olabilecek deneysel ve alternatif tedavi edici yöntemler de kitapta ayrıca tartışılmıştır.
