Reference
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1. Bakal CW, Sacks D, Burke DR, et al. Quality improvement guidelines for adult percutaneous abscess and fluid drainage. J Vasc Interv Radiol. 2003;14(9 Pt 2):S223-225. Review/Other-Dx N/A To provide guidelines to be used in quality improvement programs to assess percutaneous drainage procedures. N/A 4
2. Arellano RS, Gervais DA, Mueller PR. CT-guided drainage of abdominal abscesses: hydrodissection to create access routes for percutaneous drainage. AJR. 2011;196(1):189-191. Review/Other-Dx 12 patients with 12 abscesses To determine the clinical effectiveness of CT-guided injection of 0.9% saline solution into the retroperitoneal space to create access routes for imaging-guided percutaneous abscess drainage. Over a 10-year period, 23 patients (20 men; average age, 54 y; range, 34–77 y) with 24 mediastinal abscesses underwent 25 CT-guided drainage procedures. Abscess etiologies included esophageal leak after esophagectomy (n = 6), perforated esophageal cancer (n =4), Nissen fundoplication (n = 3), emetogenic esophageal rupture (n =3), infectious (n =2), cardiac surgery (n =1), iatrogenic (n =1), gastric strangulation (n =1), Whipple procedure (n = 1), and thoracotomy for lung cancer (n =1). Drainages were performed with tandem trocar (n =14) or Seldinger (n =11) technique. A total of 25 catheters were used: 8.5 F (n = 9), 10 F (n =8), 12 F (n =6), 14 F (n =1), and 16 F (n =1). The mean time of catheter drainage was 13.6 days. Technical success was achieved in all 25 attempts (100%). Twenty-two of the 23 patients had complete resolution of the abscess without the need for surgical debridement, for a clinical success rate of 95.6%. One patient underwent technically and clinically successful abscess drainage but required surgical exploration for repair of an anastomotic leak after esophagogastrectomy. There was one complication. One patient had inadvertent placement of a catheter within a pulmonary vein. The catheter was removed after 24 hours without hemodynamic consequences. 4
3. Ciftci TT, Akinci D, Akhan O. Percutaneous transhepatic drainage of inaccessible postoperative abdominal abscesses. AJR Am J Roentgenol. 2012;198(2):477-481. Observational-Tx 30 patients To evaluate the safety and efficacy of transhepatic drainage of inaccessible postoperative intraabdominal abscesses under sonographic and fluoroscopic guidance. The technical and clinical success rates were 100% and 97%. The procedures were performed with 8-, 10-, and 12-French locking pigtail catheters. The catheters were in place for a mean duration of 75 days if a fistula was present and 15 days in the absence of fistula. Major complications were not detected during treatment. The rate of minor complications (catheter dislodgement, obstruction, kinking) was 20%. Most of the complications were managed by exchange, revision, or increase in size of the catheter. When use of an 8-French catheter was compared separately with use of 10- and 12-French catheters, the rate of minor complications was found to be significantly higher for the 8-French group (p < 0.05). Five abscesses had fistulous communication with the pancreatic duct, jejunum, and biliary system. The mean duration of catheter use was increased by the presence of a fistula (p < 0.05). When single-microbe, polymicrobial, and culture-negative abscesses were compared, the difference between groups with respect to mean duration of catheter use was not statistically significant (p > 0.05). Mean duration also did not differ significantly between patients with an abscess volume greater than and those with an abscess volume less than 100 mL (p > 0.05). 2
4. Yamakado K, Takaki H, Nakatsuka A, et al. Percutaneous transhepatic drainage of inaccessible abdominal abscesses following abdominal surgery under real-time CT-fluoroscopic guidance. Cardiovasc Intervent Radiol. 2010;33(1):161-163. Observational-Tx 12 consecutive patients To evaluate the safety, feasibility, and clinical utility of transhepatic drainage of inaccessible abdominal abscesses retrospectively under real-time computed tomographic (CT) guidance. For abdominal abscesses, 12 consecutive patients received percutaneous transhepatic drainage. Abscesses were considered inaccessible using the usual access route because they were surrounded by the liver and other organs. The maximum diameters of abscesses were 4.6–9.5 cm (mean, 6.7 ± 1.4 cm). An 8-Fr catheter was advanced into the abscess cavity through the liver parenchyma using real-time CT fluoroscopic guidance. Safety, feasibility, procedure time, and clinical utility were evaluated. Drainage catheters were placed with no complications in abscess cavities through the liver parenchyma in all patients. The mean procedure time was 18.8 ± 9.2 min (range, 12–41 min). All abscesses were drained. They shrank immediately after catheter placement. 3
5. vanSonnenberg E, Mueller PR, Ferrucci JT, Jr. Percutaneous drainage of 250 abdominal abscesses and fluid collections. Part I: Results, failures, and complications. Radiology. 1984;151(2):337-341. Review/Other-Tx 212 patients To summarize the results, failures and complications of percutaneous abscess and fluid drainage procedures. Also, analysis and corrective measures of these problems are discussed. In 209 cases, operation was avoided and the patients were cured (83.6%). Partial success was achieved in 18/41 recurrences and failures. Cures and partial successes totaled 227/250 (90.8%). Noninfected collections were successfully drained in 31/43 cases. There were 21 failures (8.4%) and 20 recurrences (8%). 26 patients experienced complications (10.4%), seven of which were major (2.8%). 4
6. Laopaiboon V, Aphinives C, Prawiset P. Comparison of clinical success between CT-guided percutaneous drainage and open surgical drainage of intra-abdominal fluid collection in Srinagarind Hospital. J Med Assoc Thai. 2010;93 Suppl 3:S45-51. Observational-Tx 43 patients To compare clinical success of CT-guided percutaneous drainage with open surgical drainage of intra-abdominal fluid collections in Srinagarind hospital. There was no statistically significant difference (p-value = 0.520) in the clinical success between CT-PCD group (25/ 29 patients, 86.2%) and OSD group (11/14 patients, 78.5%). Complication in four patients (including one death) was found in the OSD group compared to zero patients in the CT-PCD group. The proportion of lesion subsided after CT-PCD (25/28 patients, 89.3%) was higher than OSD (10/14 patients, 71.4%). The mean times of hospital stay were 20.2 days in PCD and 24.5 days in OSD groups. 2
7. Kumar RR, Kim JT, Haukoos JS, et al. Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum. 2006;49(2):183-189. Observational-Tx 114 patients To evaluate the use of antibiotic therapy and percutaneous image-guided drainage in adult patients with intra-abdominal abscesses. The majority of the patients with intra-abdominal abscesses improved with antibiotic therapy alone. Those patients with an abscess diameter >6.5 cm and temperature at admission >101.2 degrees F have higher likelihood of failing conservative therapy with antibiotics alone and requiring percutaneous drainage. 2
8. Siewert B, Tye G, Kruskal J, et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol. 2006;186(3):680-686. Observational-Dx 181 patients To evaluate CT for the presence of an abscess, its location, maximum diameter, and feasibility of PAD and to determine whether abscess size can be used as a discriminating factor to guide management of patients with diverticular abscesses. Patients with abscesses <3 cm in size can be treated with antibiotics alone and, in some cases, as outpatients, and may not uniformly require surgery. This is also likely true for patients with abscesses 3-4 cm in size. Patients with abscesses =4 cm can be managed with CT-guided abscess drainage followed by referral for surgical treatment. 3
9. Parc Y, Frileux P, Schmitt G, Dehni N, Ollivier JM, Parc R. Management of postoperative peritonitis after anterior resection: experience from a referral intensive care unit. Dis Colon Rectum. 2000;43(5):579-587; discussion 587-579. Observational-Tx 32 patients To evaluate aggressive, one-stage surgical management of postoperative peritonitis after anterior resection. Four patients died (12 percent), and five patients (16 percent) had recurrent sepsis. When the anastomosis had been conserved, restoration of continuity was achieved in all cases. After Hartmann's operation 8 patients of 19 survivors kept a permanent stoma; 7 had undergone a low anterior resection. 3
10. Bouali K, Magotteaux P, Jadot A, et al. Percutaneous catheter drainage of abdominal abscess after abdominal surgery. Results in 121 cases. J Belge Radiol. 1993;76(1):11-14. Observational-Tx 121 patients To describe our experience with percutaneous drainage of abcesses occurring after abdominal and pelvic surgery. One hundred and twenty-one peritoneal, retroperitoneal and pelvic abscesses were treated percutaneously using CT or US guidance. The lesions developed after abdominal surgery. Sixty-three abscesses (52%) were situated in the peritoneal cavity, 31 (26%) in the retroperitoneal cavity and 27 (22%) in the pelvis. A definitive treatment was obtained in 74% of peritoneal abscesses, 67% of retroperitoneal abscesses and 82% of pelvic abscesses. Failure most commonly occurred with multiloculated lesions or lesions associated with fistulous communication. There was a low rate of complication (1%). 3
11. Cinat ME, Wilson SE, Din AM. Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg. 2002;137(7):845-849. Observational-Tx 96 patients To refine the judgement leading to a recommendation for PCD by determining the characteristics of intra-abdominal abscess that result in resolution of the infection without laparotomy. The study included 96 patients (59% men; mean +/- SD age, 48 +/- 17 years; mean +/- SD Acute Physiology and Chronic Health Evaluation II score, 7.4 +/- 4.9). Postoperative abscess was present in 53% of patients. Isolated microorganisms included Bacteroides species (17%), Escherichia coli (17%), Streptococcus species (14%), Enterococcus species (10%), and fungi (11%). Single abscesses were present in 83% of patients. Computed tomographic guidance was used for drainage in 80% of patients, and ultrasound was used in 20%. The duration of abscess drainage was less than 14 days in 64%. Complete resolution of the infection with a single treatment of PCD was achieved in 67 patients (70%), and with a second attempt in 12 (12%). Thirty-three patients (34%) had PCD for the resolution of intra-abdominal sepsis prior to an elective, definitive procedure. Open drainage as a result of PCD failure was required in 15 (16%) and was more likely in patients with yeast (P<.001) or a pancreatic process (P =.02). Postoperative abscess (P =.04) was an independent predictor of successful outcome. 2
12. Khurrum Baig M, Hua Zhao R, Batista O, et al. Percutaneous postoperative intra-abdominal abscess drainage after elective colorectal surgery. Tech Coloproctol. 2002;6(3):159-164. Observational-Tx 40 patients To examine the clinical characteristics and outcomes of patients undergoing percutaneous drainage of intra-abdominal abscesses arising after elective colorectal procedures. Percutaneous CT-guided abscess drainage is an effective method for treating intra-abdominal abscess following elective colorectal surgery. The primary success was 65% after the first and 85% after a second drainage. This technique should be considered as the treatment of choice in patients with localized intra-abdominal abscess without signs of generalized peritonitis. 3
13. Gaertner WB, Willis DJ, Madoff RD, et al. Percutaneous drainage of colonic diverticular abscess: is colon resection necessary?. Dis Colon Rectum. 56(5):622-6, 2013 May. Observational-Tx 218 patients To review the outcomes of patients who underwent percutaneous drainage of colonic diverticular abscess without subsequent operative intervention. Two hundred eighteen patients underwent percutaneous drainage of colonic diverticular abscesses. Thirty-two patients (15%) did not undergo subsequent colonic resection. Abscess location was pelvic (n = 9) and paracolic (n = 23), the mean abscess size was 4.2 cm, and the median duration of percutaneous drainage was 20 days. The comorbidities of this group of patients included severe cardiac disease (n = 16), immunodeficiency (n = 7), and severe pulmonary disease (n = 6). Freedom from recurrence at 7.4 years was 0.58 (95% CI 0.42-0.73). All recurrences were managed nonoperatively. Recurrence was significantly associated with an abscess size larger than 5 cm. Colectomy-free survival at 7.4 years was 0.17 (95% CI 0.13-0.21). 2
14. Poritz LS, Koltun WA. Percutaneous drainage and ileocolectomy for spontaneous intraabdominal abscess in Crohn's disease. J Gastrointest Surg. 2007;11(2):204-208. Review/Other-Tx 19 patients To evaluate the success of our current percutaneous protocol protocol with regard to length of stay, complications associated with the protocol, and its ability to avoid stoma creation. Nineteen patients (11 male) were identified. Sixteen underwent ileocolectomy with primary anastomosis while only three patients required an upstream diverting ileostomy in addition to resection due to incompletely drained abscesses. The mean length of hospital stay was 13.9 +/- 0.6 days including 6.4 +/- 0.4 postoperative days. Four patients had post-op complications that did not require surgery (two self-limited anastomotic bleeds, one wound infection, and one pelvic abscess treated with a percutaneous drain). One patient needed reoperation for a small bowel obstruction. 4
15. Xie Y, Zhu W, Li N, Li J. The outcome of initial percutaneous drainage versus surgical drainage for intra-abdominal abscesses in Crohn's disease. Int J Colorectal Dis. 2012;27(2):199-206. Observational-Tx 23 patients To retrospectively analyze the outcome of initial PD versus initial surgical drainage for intra-abdominal abscesses in Crohn's disease. Patients were divided into initial PD group (n = 10) and initial surgery group (n = 13): post-drainage complications were more common in initial surgery group (2/10 vs 9/13, P = 0.036), abscess recurred in three patients (2/10 vs 1/13, NS), and subsequent surgery was needed in 10 patients (6/10 vs 4/13, NS). Ultimate stoma creation were significantly more in initial surgery group (1/10 vs 9/13, P = 0.01). 2
16. Gervais DA, Hahn PF, O'Neill MJ, Mueller PR. Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years. Radiology. 2002;222(3):645-651. Review/Other-Dx 32 patients To determine technical success with PAD in patients with Crohn’s disease during 14 years. The technical success rate was 96%. In 16 (50%) of 32 patients, the need for surgery in the short term was avoided, and surgery was more likely to be avoided in patients with postoperative abscesses than in those with spontaneous abscesses (P =.07). At long-term follow-up, short-term avoidance of surgery did not significantly increase the likelihood of need for surgery in the long term, which occurred in nine of 16 short-term successes versus five of 15 short-term failures (P =.55). Recurrent abscesses occurred in seven (22%) patients, a rate comparable to that with surgical abscess drainage; four (44%) of nine cases of re-drainage were successful. 4
17. Gutierrez A, Lee H, Sands BE. Outcome of surgical versus percutaneous drainage of abdominal and pelvic abscesses in Crohn's disease. Am J Gastroenterol. 2006;101(10):2283-2289. Observational-Tx 66 patients To examine the effect of either surgical or percutaneous drainage therapy on time to resolution of abdominal and pelvic abscesses in Crohn’s disease. Time to resolution of abdominal or pelvic abscesses in Crohn’s disease is similar with percutaneous drainage and surgery. One-third of patients treated with percutaneous drainage required surgery within 1 year. Earlier intervention for abdominal and pelvic abscesses is associated with shorter time to resolution. 2
18. Muller-Wille R, Iesalnieks I, Dornia C, et al. Influence of percutaneous abscess drainage on severe postoperative septic complications in patients with Crohn's disease. Int J Colorectal Dis. 2011;26(6):769-774. Review/Other-Tx 25 patients To compare the incidence of severe postoperative intra-abdominal septic complications in patients undergoing intestinal resections with and without preoperative PAD before definitive surgery. The incidence of postoperative intra-abdominal septic complications in patients with (group I) and without (group II) preoperative PAD (Fisher's exact test) were compared. PAD was performed in 12/25 patients (48%), with an average of 37 days before surgery (range, 6-83 days). The overall rate of postoperative intra-abdominal septic complications was 48% (12/25 patients). In group I, postoperative intra-abdominal septic complications occurred in 3/12 patients (25%). In group II, postoperative intra-abdominal septic complications were assessed in 9/13 patients (69%). The differences between these two groups were considered to be statistically significant (P=0.04). PAD of intra-abdominal abscesses before surgery could significantly reduce the occurrence of severe postoperative intra-abdominal septic complications in patients with Crohn’s disease. 4
19. Bafford AC, Coakley B, Powers S, et al. The clinical impact of preoperative percutaneous drainage of abdominopelvic abscesses in patients with Crohn's disease. Int J Colorectal Dis. 2012;27(7):953-958. Observational-Tx 70 patients To compare outcomes following the treatment of intra-abdominal Crohn's abscesses with percutaneous drainage followed by surgery to those after surgery alone. Seventy patients with Crohn's disease-related abdominopelvic abscesses were identified, 38 (54%) of whom underwent drainage before surgery. Percutaneous drainage was technically successful in 92% of patients and clinically successful in 74% of patients. No differences in rate of septic complications (p = 0.14) or need for stoma creation (p = 0.78) were found. Patients who underwent percutaneous drainage had greater overall hospital lengths of stay (mean 15.8 versus 12.2 days, p = 0.007); 8.6% of patients had long-term postponement of surgery after percutaneous drainage. 2
20. Hussain MI, Al-Akeely MH, Alam MK, Al-Qahatani HH, Al-Salamah SM, Al-Ghamdi OA. Management of appendiceal abscess. A 10-year experience in Central Saudi Arabia. Saudi Med J. 2012;33(7):745-749. Observational-Tx 80 patients To study the outcome of patients with appendiceal abscess (AA) following immediate operative and non-operative management in terms of complications and hospital stay. Eighty AA patients were managed during the study period. Forty-two patients (52.5%) received NOM, while 38 patients (47.5%) underwent immediate OM. The complication rate was significantly higher in the OM group compared with the NOM group (44.7% versus 11.9%; p=0.0012). Successful NOM was achieved in 92.8% of patients. The overall mean hospital stay of the NOM group was 8.54+/-2.25, and the OM group was 10.86+/-4.32 days (p=0.003). 2
21. Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI. Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis. Arch Surg. 2005;140(9):897-901. Observational-Tx 32,938 patients To determine the risk of recurrent appendicitis following initial nonoperative treatment for appendicitis, and evaluate factors associated with recurrence. The type of appendicitis was abscess in 7% of patients, peritonitis in 18%, and no peritonitis or abscess in 75%. Emergency appendectomy was performed in 31,926 (97%) patients. Nonoperative treatment was used initially in 1012 patients (3%). Of these, 148 (15%) had an IA and the remaining 864 (85%) did not. Thirty-nine patients (5%) recurred after a median follow-up of 4 years. Using Cox regression, sex had a slight influence on recurrent appendicitis (hazard ratio males vs females = 0.52, 95% CI, 0.27-0.99, P = .05). Age, Charlson comorbidity index, type of appendicitis, or percutaneous abscess drainage had no influence on recurrence. Median length of hospital stay was 4 days for the admission for recurrent appendicitis compared with 6 days for the IA admission (P = .006). 3
22. Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery. 2010;147(6):818-829. Meta-analysis 17 studies To compare the outcomes of patients presenting with complicated appendicitis who underwent CT with or without interval appendectomy (IA) versus patients who underwent acute appendectomy (AA). Seventeen studies (16 nonrandomized retrospective and 1 nonrandomized prospective) reported on 1,572 patients: 847 patients received conservative treatment and 725 had acute appendectomy. Conservative treatment was associated with significantly less overall complications, wound infections, abdominal/pelvic abscesses, ileus/bowel obstructions, and reoperations. No significant difference was found in the duration of first hospitalization, the overall duration of hospital stay, and the duration of intravenous antibiotics. Overall complications remained significantly less in the conservative treatment group during sensitivity analysis of studies including only pediatric patients, high-quality studies, more recent studies, and studies with a larger group of patients. Inadequate
23. Gee MS, Kim JY, Gervais DA, Hahn PF, Mueller PR. Management of abdominal and pelvic abscesses that persist despite satisfactory percutaneous drainage catheter placement. AJR Am J Roentgenol. 2010;194(3):815-820. Observational-Tx 2,224 patients To determine the frequency with which percutaneous abdominopelvic abscess drainage catheters must be replaced because of inadequate drainage, to assess the effect of percutaneous catheter exchange on clinical outcome, and to determine the predictors of clinical success after catheter exchange. Among the 3,027 percutaneous abscess drainage catheters placed, 82 were exchanged because of lack of improvement (imaging evidence of undrained fluid and persistent fever and leukocytosis), for an overall frequency of catheter exchange of 2.7% of abscesses in 3.7% of patients. The success rate of catheter replacement, defined as resolution of the fluid collection without open surgical drainage, was 76.8% (63/82). Prognostic factors favorably influencing the clinical success of catheter exchange included a larger number of drainage catheter sideholes, absence of a fistula, low residual abscess volume after initial catheter drainage, and low CT attenuation of abscess fluid. 2
24. Bae JH, Kim GC, Ryeom HK, Jang YJ. Percutaneous embolization of persistent biliary and enteric fistulas with Histoacryl. J Vasc Interv Radiol. 2011;22(6):879-883. Review/Other-Tx 11 patients To describe our experience with transcatheter n-butyl-2-cyanoacrylate (NBCA) embolization of refractory enteric or biliary fistulas In all patients, enteric or biliary fistula output ceased after one or two procedures without any complications. No recurrence was noted during follow-up of 9-17 months. 4
25. Beland MD, Gervais DA, Levis DA, Hahn PF, Arellano RS, Mueller PR. Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology. 2008;247(2):567-573. Review/Other-Tx 43 patients To retrospectively evaluate the effectiveness and safety of tPA for drainage of abdominal and pelvic abscesses refractory to simple catheter drainage. Intracavitary tPA is safe and effective for draining complex fluid collections, with most patients avoiding surgery. 4
26. Gervais DA, Levis DA, Hahn PF, Uppot RN, Arellano RS, Mueller PR. Adjunctive intrapleural tissue plasminogen activator administered via chest tubes placed with imaging guidance: effectiveness and risk for hemorrhage. Radiology. 2008;246(3):956-963. Observational-Tx 66 patients To retrospectively determine the effectiveness of and risk for hemorrhage with intrapleural adjunctive tPA administered via chest tubes placed with imaging guidance. 57 (86%) of 66 patients underwent complete drainage with tPA without further surgical procedures. Primary effectiveness was seen in 52 (87%) of 60 patients and secondary effectiveness was seen in five (83%) of six. Intrapleural tPA is effective in improving drainage of loculated effusions not drained with catheters alone; prophylactic systemic anticoagulation does not increase bleeding risk with intrapleural tPA, but therapeutic anticoagulation is associated with a significantly increased risk of pleural hemorrhage. 3
27. Statler JD, Doherty RD, McLaughlin JJ, Gleason JD, McDermott MP. Tissue plasminogen activator in the percutaneous drainage of splenic abscess. J Vasc Interv Radiol. 2010;21(2):307-309. Review/Other-Tx 2 patients To describe the safe application of fibrinolysis in two cases of splenic abscess. Two cases in which tPA was used as an adjuvant treatment in the drainage of complex splenic abscesses are presented. The authors belief that fibrinolytic therapy in the treatment of complex splenic abscesses results in more rapid and more successful resolution of these collections. According to the authors, their experiences indicate that the use of TPA to assist in the drainage of splenic abscess is safe, and further investigation of this practice is warranted. 4
28. Laborda A, De Gregorio MA, Miguelena JM, et al. Percutaneous treatment of intrabdominal abscess: urokinase versus saline serum in 100 cases using two surgical scoring systems in a randomized trial. Eur Radiol. 2009;19(7):1772-1779. Experimental-Tx 100 patients Randomized trial to assess whether regular instillation of urokinase during abscess drainage leads to an improved outcome compared to saline irrigation alone. Patients were randomized between thrice daily urokinase instillation or saline irrigation alone. Patient medical records were reviewed to determine drainage, study group, Altona (PIA II) and Mannheim (MPI) scoring, duration of drainage, procedure-related complications, and hospital stay duration, and clinical outcome at the end of study. Technical success rate of the PAD was 100%. The success or failure of abscess remission did not differ significantly between groups (success rate of 91.5% in the urokinase group vs 88.8% in the saline group; failure rate was of 8.5% vs 21.2%, respectively); however, days of drainage, main hospital stay, and overall costs were significantly reduced in patients treated with urokinase compared to the control group (P<0.05). Surgical scores were a useful homogeneity factor, and MPI showed a good correlation with prognosis, while PIA results did not have a significant correlation. For drainage of complex abscesses (loculations, hemorrhage, viscous material), fibrinolytics safely accelerate drainage and recovery, reducing the length of the hospital stay and, therefore, the total cost. 1
29. Cheng D, Nagata KT, Yoon HC. Randomized prospective comparison of alteplase versus saline solution for the percutaneous treatment of loculated abdominopelvic abscesses. J Vasc Interv Radiol. 2008;19(6):906-911. Experimental-Tx 20 patients To determine if alteplase infusion for the treatment of loculated abdominopelvic abscesses requiring PCD was superior to saline solution infusion. There was no significant difference in the distribution of sex (P=.08) or age (P=.29). Abscess resolution was achieved in 9/11 alteplase-treated patients (80%) vs 3/9 saline solution-treated patients (33%). However, one patient in each group required repeat intervention within 30 days, for overall success rates of 73% vs 22%, respectively (P=.02). Having observed a significant difference in the primary outcome variable, the study was terminated early. A 3-day course of twice-daily alteplase infusion therapy is superior to normal saline solution for the treatment of loculated abdominopelvic abscesses. 1
30. Demir E, Alan C, Kilciler M, Bedir S. Comparison of ethanol and sodium tetradecyl sulfate in the sclerotherapy of renal cyst. J Endourol. 2007;21(8):903-905. Observational-Tx 65 patients To compare the efficacy and side effects of ethanol and sodium tetradecyl sulfate as sclerosants for symptomatic simple renal cyst. Ethanol and sodium tetradecyl sulfate are simple, noninvasive, cost-effective, and well-tolerated sclerosants for the treatment of simple renal cysts. Prefer sodium tetradecyl sulfate as a first choice because it causes less pain (pain score 2.1 ± 1.1 vs 3.8 ± 1.2 for ethanol; P=0.019). 1
31. Do H, Lambiase RE, Deyoe L, Cronan JJ, Dorfman GS. Percutaneous drainage of hepatic abscesses: comparison of results in abscesses with and without intrahepatic biliary communication. AJR Am J Roentgenol. 1991;157(6):1209-1212. Observational-Tx 30 Patients To analyze 2 groups (patients with intrahepatic biliary communication vs patients without biliary communication) to determine whether the presence of an intrahepatic biliary communication affected the outcome of treatment. Duration of drainage was longer (P<.05) in patients with communication (range, 7-44 days; mean, 22 days) than in patients without communication (range, 1-33 days; mean, 13 days). Percutaneous drainage was curative in five (63%) and palliative or temporizing in one (13%) of eight patients with communication. It was curative in 15 (68%) and palliative or temporizing in five (23%) of 22 patients without communication (P=.317). 2
32. Schuster MR, Crummy AB, Wojtowycz MM, McDermott JC. Abdominal abscesses associated with enteric fistulas: percutaneous management. J Vasc Interv Radiol. 1992;3(2):359-363. Review/Other-Tx 24 Patients To analyze percutaneous methods used in the management of abdominal abscesses with fistulas. Initial drainage of their abscesses was performed in the hospital, but 17 of 24 patients were discharged with a tube in place and were followed up as outpatients. The duration of drainage ranged from 4 days to 3 months. Fistulas healed in 21 of 24 patients (88%) without surgical intervention. Complications were few and included inadvertent dislodgment requiring tube replacement (two patients) and inadvertent puncture of the transverse colon (one patient). 4
33. Mueller PR, White EM, Glass-Royal M, et al. Infected abdominal tumors: percutaneous catheter drainage. Radiology. 1989;173(3):627-629. Review/Other-Tx 16 patients To analyze use of PCD in infected primary or metastatic abdominal tumors. Twelve of the patients improved clinically, as evidenced by defervescence and decrease or normalization of leukocytosis. Four patients did not respond to catheter drainage and required surgery. Three of the twelve who improved underwent operations for attempts at surgical cure or debulking of tumor volume despite an initial "good" response to percutaneous drainage. Of the nine patients who did not undergo surgery after percutaneous drainage, four underwent catheter removal after 5 weeks of drainage and had no recurrence of infection, two remained alive with the catheter in place up to 8 months and 1 year after drainage, and two died with the catheter in place. One patient had the catheter removed inadvertently after 3 weeks of drainage and had recurrences that required replacement of the catheter until his death. 4
34. Chang KC, Chuah SK, Changchien CS, et al. Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. World J Gastroenterol. 2006;12(3):460-464. Observational-Dx 67 patients To analyze 67 cases of splenic abscess in a medical center of Taiwan during a period of 19 years. There were 41 males and 26 females with the mean age of 54.1+/-14.1 years. Multiple splenic abscesses (MSA) account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixty-seven patients (35.8%) had extrasplenic abscesses, with leading site of liver (34.6%). Microbiological cultures were positive in 58 patients (86.6%), with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus (GNB) infection predominated (55.2%), with leading pathogen of Klebsiella pneumoniae (22.4%), followed by gram positive coccus (GPC) infection (31%). Splenectomy was performed in 26 patients (38.8%), percutaneous drainage or aspiration in 21 (31.3%), and antibiotic therapy alone in 20 patients (29.9%). Eventually, 12 of 67 patients expired (17.9 %). By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC (P=0.036). Patients with GNB infection (P=0.009) and multiple abscesses (P=0.011) experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE II score of 12 expired patients (16.3+/-3.2) was significantly higher than that of the 55 survivals (7.2+/-3.8) (P<0.001). 3
35. Tung CC, Chen FC, Lo CJ. Splenic abscess: an easily overlooked disease? Am Surg. 2006;72(4):322-325. Observational-Tx 51 patients To analyze the demographics, clinical manifestations, etiology, predisposing factors, diagnostic modalities, bacteriologic profile, treatment, and outcome of patients with splenic abscess. The mean age was 59.9 ± 14.2 years (ranging from 21–89 years). The male:female ratio was 29:22. Common symptoms included fever (82%), abdominal pain (71%), and nausea and vomiting (46%). The majority of these patients (83%) had leukocytosis. Thirty-six patients had associated parenchymal liver diseases and 26 patients had diabetes mellitus. Abdominal sonogram or computed tomography was performed to establish the diagnosis. Most cultures from the abscess cavities grew gram-negative enteric bacilli. Patients were treated with antimicrobial therapy only (n = 33), additional percutaneous drainage with a pigtail catheter (n = 11), or splenectomy (n = 7), and the survival rates were 48 per cent, 45 per cent, and 100 per cent, respectively. 2
36. Choudhury SR, Debnath PR, Jain P, et al. Conservative management of isolated splenic abscess in children. J Pediatr Surg. 2010;45(2):372-375. Review/Other-Dx 18 children To report a single-center experience with emphasis on the diagnosis, etiology, treatment, and outcome of isolated splenic abscesses in children. Eighteen children (age, 3-16 years; male-female ratio, 5:1) were managed over a period of 8 years in a tertiary-care institution. Presenting symptoms included fever, abdominal pain, and anorexia. Splenomegaly was present in 12 (67%), leukocytosis in 9 (50%), and thrombocytosis in 12 (67%) patients. Associated diseases were thalassemia (1), tuberculosis (1), and typhoid fever (9). Solitary and multiple SAs were seen in equal numbers. Blood culture grew Salmonella paratyphi A in 1 case. Splenic aspirate culture was positive in 3 (Escherichia coli [1], S paratyphi A [1], Acinetobacter [1]). Widal serology was positive in 9 (50%) patients. Management consisted of intravenous broad-spectrum antibiotic therapy in all patients, together with percutaneous aspiration in 10 (56%) cases where the abscess size was greater than 3 cm. All patients responded, and complete resolution was observed. 4
37. Lee WS, Choi ST, Kim KK. Splenic abscess: a single institution study and review of the literature. Yonsei Med J. 2011;52(2):288-292. Review/Other-Dx 18 patients To review our experience with splenic abscesses, with respect to the relevant aspects of splenic abscesses and treatment outcomes The most common symptom at presentation was abdominal pain in 12 patients (66.7%). The median duration from symptom onset until establishment of a diagnosis was 22 days. Streptococcus viridans was the most common pathogen (27.8%), follow by Klebsiella pneumoniae (22.2%). The mortality rate during the inpatient period and the previous 90 days was 16.6%. Three of four patients with Klebsiella pneumoniae showed a single abscess pocket. Four patients (22.2%) underwent percutaneous drainage, eight (44.5%) received antibiotic treatment only and six (33.3%) underwent splenectomy. 4
38. Mezhir JJ, Fong Y, Fleischer D, et al. Pyogenic abscess after hepatic artery embolization: a rare but potentially lethal complication. J Vasc Interv Radiol. 2011;22(2):177-182. Review/Other-Dx 971 patients underwent 2,045 HAE procedures To identify clinical factors associated with postembolization abscess, which may improve management and outcome. From January 1998 to January 2010, 971 patients underwent 2,045 HAE procedures. Fourteen patients developed a pyogenic hepatic abscess after embolization, for an overall rate of 1.4%. Thirty-four patients (4%) had a history of bilioenteric anastomosis (BEA) and 21 patients (2%) lacked a competent sphincter of Oddi because of the presence of a biliary stent (n = 19) or a previous sphincterotomy (n = 2). Eleven of the 34 patients with a BEA (33%) and two of 21 patients with an incompetent sphincter (10%) developed abscesses, in contrast to only one abscess (0.05%) among the 916 patients with apparently normal sphincters (0.1%; odds ratio, 437.6; 95% CI, 54.2-3,533; P < .0001). Gram-negative and Gram-positive aerobes were the most common bacteria isolated after drainage. Percutaneous drainage was the initial management strategy in all patients; two patients (14%) required subsequent surgical drainage and hepatectomy, and three (21%) died. 4
39. Law ST, Kong Li MK. Is there any difference in pyogenic liver abscess caused by Streptococcus milleri and Klebsiella spp?: retrospective analysis over a 10-year period in a regional hospital. J Microbiol Immunol Infect. 46(1):11-8, 2013 Feb. Review/Other-Dx 161 patients To compare the clinical characteristics of patients with Streptococcus milleri (SM) and Klebsiella spp. associated pyogenic liver abscess (PLA). From 2000 to 2009 inclusive, 21 and 140 patients had SM and Klebsiella spp. associated monomicrobial infected PLA, respectively. A higher incidence of active malignancy occurred in the SM group (14.3% vs. 3.6%, p < 0.03). The common clinical features of the patients were fever, chill and right upper quadrant pain. A longer duration (6.3 vs. 4.4 day, p = 0.04) of symptoms and a higher incidence of hepatomegaly (14.3% vs. 2.9%, p < 0.01) occurred in the SM group. Common laboratory and imaging abnormalities included: anemia, leukocytosis, high erythrocyte sedimentation rate and C-reactive protein, hypoalbuminemia, elevated total bilirubin and alanine aminotransferase, right hepatic lobe involvement, hypoechoic in ultrasonograpghy, rim enhancement and septal lobulation in computed tomography. The biliary tract disorder was the most common cause of the disease in the two groups. Patients with Klebsiella spp. associated PLA tended to have more complications: bacteremia (61.6% vs. 31.6%, p < 0.01) septic shock (33.6% vs. 19%, p = 0.11), disseminated intravascular coagulation (20.7% vs. 4.8%, p = 0.04), metastatic infections (10.7% vs. 0%, p = 0.06), acute renal and respiratory failure (5% vs. 0%, p = 0.14). However, both were effectively managed by the combination of antibiotics and image-guided aspiration with/without drainage, and their mortality rates were comparable to each other. Those patients with metastatic infection might need a longer duration (6.07 vs. 5.32 week, p = 0.144) of antibiotic therapy, which was due to the longer mean duration (3.85 vs. 2.86, p < 0.04) of an intravenous counterpart. 4
40. Qin SL, Wang AX, Sheng RY, Liu ZY. [Clinical analysis of 36 cases with amebic liver abscess]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2000;18(6):356-358. Review/Other-Tx 36 patients To investigate the clinical features of amebic liver abscess, the causes of misdiagnosis and the effect of medical and surgical therapy on patient’s prognosis. The major clinical manifestations were: abdominal pain (86.1%), fever (86.1%), hepatomegaly with tenderness (83.3%) and right intercostal tenderness (58.3%). Leukocytosis was observed in 61.1%, and increased of ESR in 88.5% (23/28). Serologies against Entamoeba histolytica were noted in 92.6%. Ultrasonography showed single lesions in 75% and right-lobe involvement in 75%. All patients were treated with metronidazole and 27 patients received treatment with needle aspiration or draining at the same time. After treatment, 10 patients were cured, 25 patients were improved significantly and effective rate was 97.2%. One patient died of hepatic failure. 4
41. Stain SC, Yellin AE, Donovan AJ, Brien HW. Pyogenic liver abscess. Modern treatment. Arch Surg. 1991;126(8):991-996. Review/Other-Tx 54 patients To review records of patients with pyogenic live abscess to determine whether earlier diagnosis with current imaging tests and definitive treatment with antibiotics, aspiration, or catheter drainage was an effective alternative to open drainage. Twenty-nine patients were treated with broad-spectrum antibiotics and diagnostic aspiration. Twenty-three (79%) recovered uneventfully, and six required catheter or operative drainage. Twenty-three patients (including five who failed aspiration) underwent drainage with percutaneously placed catheters. Nineteen (83%) recovered; four required open surgical drainage. Of seven patients who required open surgical drainage, six recovered. One (2%) of the 54 patients died following failed aspiration and catheter and surgical drainage. Four patients were successfully treated with antibiotics alone without aspiration. 4
42. Bradley EL, 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128(5):586-590. Review/Other-Dx N/A To propose a classification system for acute pancreatitis that will be of value to practicing clinicians in the care of individual patients and to academicians seeking to compare interinstitutional data. No results stated in abstract. 4
43. Giovannini M, Pesenti C, Rolland AL, Moutardier V, Delpero JR. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo endoscope. Endoscopy. 2001;33(6):473-477. Observational-Tx 35 patients To evaluate a new drainage technique for pancreatic pseudocysts or pancreatic abscesses entirely guided by endoscopic US and using an interventional echo endoscope with a linear curved array transducer. No major complication occurred except in one case of a pneumoperitoneum, which was managed medically. Placement of the 7-F nasocystic drain was successful in 18/20 cases of pancreatic abscess. Surgery was performed in the two other patients. Concerning the pancreatic pseudocysts, placement of an 8.5-French stent was successful in 10 patients and of a nasopancreatic drain in five patients. In one case, only a puncture-aspiration was performed. One recurrence among the 15 pancreatic pseudocysts and two relapses of the 18 pancreatic abscesses have been observed, over a mean follow-up of 27 months (6-48 months). EUS-guided drainage was successful in 31/35 patients (88.5%); only four patients with pancreatic abscesses underwent surgery. No bleeding occurred during the time of this study. 3
44. Lang EK, Paolini RM, Pottmeyer A. The efficacy of palliative and definitive percutaneous versus surgical drainage of pancreatic abscesses and pseudocysts: a prospective study of 85 patients. South Med J. 1991;84(1):55-64. Review/Other-Tx 85 patients To compare the efficacy of percutaneous to surgical drainage in patients with pancreatic abscesses and pseudocysts. Percutaneous drainage of pancreatic abscesses in 18 patients cured three and palliated 12 who were eventually cured by elective surgical ablation; three patients died. This compares well to our 15 surgical patients, of whom four were cured by surgery alone and six were palliated. All were subsequently cured by additional computerized tomography-guided or ultrasound-guided percutaneous drainage and medical management or surgery. Five of the 15 died. Percutaneous drainage cured 11 of 14 infected pseudocysts and palliated two, which were subsequently cured by surgery; one was palliated but the patient was lost to follow-up. Surgical drainage cured six of 12 infected pseudocysts and palliated the other six, of which four were cured by further surgery and the other two were cured by secondary percutaneous drainage. Nine of 12 noninfected pseudocysts were cured by percutaneous aspiration, and two were palliated and later cured. In one patient, disease progressed, and he was ultimately lost to follow-up. Thirteen of 14 noninfected pseudocysts were cured by surgical drainage. The other patient died of pulmonary embolus. In patients treated by percutaneous techniques, there were four major complications. 4
45. Mithofer K, Mueller PR, Warshaw AL. Interventional and surgical treatment of pancreatic abscess. World J Surg. 1997;21(2):162-168. Review/Other-Tx 39 patients To determine value of pancreatic catheter drainage (PCD) in treating patients with pancreatic abscess. We used percutaneous catheter drainage in 39 patients during 1987-1995. Only 9 of 29 (31 %) attempts at primary therapy were successful; 2 patients died, and 18 required subsequent surgical drainage. On the other hand, 14 of 14 patients with recurrent or residual abscesses after surgical drainage were successfully drained percutaneously. 4
46. Park JJ, Kim SS, Koo YS, et al. Definitive treatment of pancreatic abscess by endoscopic transmural drainage. Gastrointest Endosc. 55(2):256-62, 2002 Feb. Observational-Tx 9 patients To assess the feasibility, safety, and effectiveness of endoscopic transmural drainage for the treatment of pancreatic abscesses compressing the gut lumen. Endoscopic transmural drainage was technically successful in all cases. Ten abscess cavities (91%) resolved completely after stent placement for a mean duration of 32 days. In 2 patients, insertion of a nasopancreatic catheter was required to irrigate thick pus or necrotic debris. Bleeding occurred in 1 case (11%) but there was no mortality. The relapse rate was 13% over a mean follow-up of 18 months. 3
47. Rotman N, Mathieu D, Anglade MC, Fagniez PL. Failure of percutaneous drainage of pancreatic abscesses complicating severe acute pancreatitis. Surg Gynecol Obstet. 1992;174(2):141-144. Review/Other-Tx 14 patients To report outcomes of patients with severe acute pancreatitis selected to undergo percutaneous drainage of pancreatic abscess, under CT scan guidance. Percutaneous drainage was performed as the primary treatment in 13 patients and for removal of a residual collection postoperatively in one patient. In two critically ill patients, percutaneous drainage was performed as a temporizing measure. In 12 patients with well-limited hypodense collections, percutaneous drainage was expected to result in the definitive cure of the abscess. Pigtail drains (No. 14F), were inserted using local anesthesia and CT scan guidance. Two patients had two drains and 12 patients had only one drain. Two patients were definitively cured by percutaneous drainage and all other patients were operated upon for removal of infected necrosis. 4
48. Steiner E, Mueller PR, Hahn PF, et al. Complicated pancreatic abscesses: problems in interventional management. Radiology. 1988;167(2):443-446. Review/Other-Tx 25 patients To report cases of patients treated with percutaneous drainage. The patients required multiple CT examinations, multiple catheter insertions, multiple catheter manipulations, and long-term catheter drainage. 8/25 patients were successfully treated with catheter drainage alone. 16 underwent surgical drainage, 10 after attempts at percutaneous drainage and 6 prior to radiologic drainage. Of the10 patients who had initial percutaneous drainage, only 4 were clinically improved from the drainage procedure alone. 4
49. Venu RP, Brown RD, Marrero JA, Pastika BJ, Frakes JT. Endoscopic transpapillary drainage of pancreatic abscess: technique and results. Gastrointest Endosc. 2000;51(4 Pt 1):391-395. Observational-Tx 22 patients To determine the effectiveness of endoscopic transpapillary drainage in patients with pancreatic abscess. Of 22 patients with pancreatic abscess, 11 underwent endoscopic transpapillary drainage with technical success in 10 patients (90%); 8 patients (74%) had resolution of pancreatic abscess, clinically and radiographically. Intracavitary instillation of gentamicin and nasopancreatic catheter drainage were used in 2 patients. Two patients in whom endoscopic transpapillary drainage failed underwent operative drainage with a favorable outcome, and the one patient in whom endoscopic treatment was technically unsuccessful underwent successful percutaneous drainage. One patient had mild pancreatitis. 3
50. Coelho RF, Schneider-Monteiro ED, Mesquita JL, Mazzucchi E, Marmo Lucon A, Srougi M. Renal and perinephric abscesses: analysis of 65 consecutive cases. World J Surg. 2007;31(2):431-436. Review/Other-Dx 65 patients To describe the last 10 years' experience of the diagnosis and treatment of renal, perinephric, and mixed abscesses in an academic reference center. Perinephric abscesses were found in 33 (50.8%) patients, renal abscesses were found in 16 (24.6%), and 16 (24.6%) had mixed abscesses. Urolithiasis (28%) and diabetes mellitus (28%) were the most common predisposing conditions. The duration of symptoms before hospital admission ranged from 2 to 180 days (mean 20 days). Urine culture was positive in 43% of patients and blood culture was positive in 40% of patients. Most of the perinephric abscesses received an interventional treatment: surgical drainage (24%), percutaneous drainage (42%) or nephrectomy (24%). Most patients were cured (73.3%) on discharge from hospital. Mixed (renal and perinephric) abscess treatment was similar: percutaneous drainage (37.5%), surgical drainage (18.75%) or nephrectomy (37.5%). Most patients were cured (60%) on discharge from hospital. Renal abscesses, however, were treated medically in 69% of patients and 73% were cured on discharge from hospital. 4
51. Yen DH, Hu SC, Tsai J, et al. Renal abscess: early diagnosis and treatment. Am J Emerg Med. 1999;17(2):192-197. Observational-Dx 88 patients To identify initial clinical characteristics that can lead to early diagnosis of renal abscess in the emergency department and predict poor prognosis. The mean age of 88 patients with renal abscess was 59.8 years. The most common predisposing disorder was diabetes mellitus, followed by renal calculi and ureteral obstruction. The duration of diagnosis by emergency physicians was shorter for group 1 patients (1.2 +/- .4 v group 2, 2.8 +/- 2.9 days; P < .01) and the blood urea nitrogen level was higher in group 1 (55.7 +/- 42.2 mg/dL, v group 2, 33.5 +/- 33.5 mg/dL; P = .02). 3
52. Moreira Jda S, Camargo Jde J, Felicetti JC, Goldenfun PR, Moreira AL, Porto Nda S. Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004. J Bras Pneumol. 2006;32(2):136-143. Review/Other-Tx 252 consecutive patients To analyze the management of patients with aspiration lung abscess. Lung abscess occurred predominantly in male adults presenting dental disease and having a history of loss of consciousness. Aspiration lung abscess is typically accompanied by unilateral cavitation, is found in zones of the lung that are preferential for aspiration and contains mixed flora. Most of the patients were treated clinically with antibiotics and postural drainage, although some surgical procedure was required in one-fifth of the study sample. 4
53. vanSonnenberg E, D'Agostino HB, Casola G, Wittich GR, Varney RR, Harker C. Lung abscess: CT-guided drainage. Radiology. 1991;178(2):347-351. Review/Other-Tx 19 patients To evaluate CT-guided drainage in the treatment of lung abscesses. The abscess was cured (by clinical and radiographic criteria) in all 19 patients (100%), and surgery was avoided in 16 of the 19 patients (84%). Three patients underwent surgery for removal of organized tissue or decortication after the lung abscess was evacuated. Complications included a hemothorax that required a chest tube in one patient and three minor complications (a clogged catheter in two patients and transient elevation of intracerebral pressure in one patient). The hemothorax occurred in one of two patients in whom the catheter traversed normal lung. The percutaneous drainage catheters traversed juxtaposed abnormal pleura on route to the abscess in 17 of the patients. 4
54. Yellin A, Yellin EO, Lieberman Y. Percutaneous tube drainage: the treatment of choice for refractory lung abscess. Ann Thorac Surg. 1985;39(3):266-270. Review/Other-Tx 48 patients To assess percutaneous tube drainage in the treatment of lung abscess. All were successfully treated by percutaneous tube drainage initiated under local anesthesia, and all recovered completely. There were no relapses after a follow-up period of 2 to 5 years. During this period, we did not perform pulmonary resection for primary lung abscess. Three patients with malignant abscesses were also treated initially by transthoracic drainage but eventually required surgical intervention. It is concluded that percutaneous transthoracic drainage is an efficient and safe mode of treatment, and recommend transthoracic drainage as the treatment of choice for long-standing, refractory primary lung abscesses 4
55. Kelogrigoris M, Tsagouli P, Stathopoulos K, Tsagaridou I, Thanos L. CT-guided percutaneous drainage of lung abscesses: review of 40 cases. JBR-BTR. 2011;94(4):191-195. Observational-Dx 40 patients To evaluate the safety and effectiveness of CT-guided percutaneous drainage of lung abscesses considering success rate versus complications. Lung abscess completely resolved with no residual cavity in thirty three patients. Seven patients had residual cavity and surgery was performed. Thus, the success rate of radiological drainage of the lung abscesses (33/40) was 83%. Five (13%) patients developed pneumothorax. Three developed moderate pneumothorax and chest-tube needed to be inserted and two patients developed mild pneumothorax which was managed with aspiration. These patients were kept under observation and followed-up by chest X-rays. No other complications and no mortality occurred during the procedure for all the forty patients. 3
56. Marom EM, Patz EF, Jr., Erasmus JJ, McAdams HP, Goodman PC, Herndon JE. Malignant pleural effusions: treatment with small-bore-catheter thoracostomy and talc pleurodesis. Radiology. 1999;210(1):277-281. Observational-Tx 32 patients To determine the value of small-bore-catheter thoracostomy and talc pleurodesis in the treatment of malignant pleural effusions. 23 patients (72%) had a complete response; four (12%), a partial response; and five (16%), no response. Symptoms in all those who responded were clinically improved. Complications included fever in 13 patients (41%) and moderate shortness of breath, chest pain, or both in six (19%). Small-bore-catheter thoracostomy and talc pleurodesis was successful in treating malignant pleural effusions. 1
57. Warren WH, Kalimi R, Khodadadian LM, Kim AW. Management of malignant pleural effusions using the Pleur(x) catheter. Ann Thorac Surg. 2008;85(3):1049-1055. Review/Other-Tx 202 patients To determine the value of the Pleur(x) catheter in treating patients with malignant pleural effusions. 231 Pleur(x) catheters were inserted into patients. Insertion of Pleur(x) catheters is an effective way to treat patients with a malignant pleural effusion on an outpatient basis with a high degree of patient compliance and few complications. Overall, almost 60% of the catheters can be removed with a very low chance of reaccumulation, and without the need to instill a sclerosing agent. 4
58. Arellano RS, Gervais DA, Mueller PR. Computed tomography-guided drainage of mediastinal abscesses: clinical experience with 23 patients. J Vasc Interv Radiol. 2011;22(5):673-677. Observational-Tx 23 patients To evaluate the technical and clinical success rates of CT-guided percutaneous drainage of mediastinal abscesses. Technical success was achieved in all 25 attempts (100%). 22/23 patients had complete resolution of the abscess without the need for surgical debridement, for a clinical success rate of 95.6%. One patient underwent technically and clinically successful abscess drainage but required surgical exploration for repair of an anastomotic leak after esophagogastrectomy. There was one complication. One patient had inadvertent placement of a catheter within a pulmonary vein. The catheter was removed after 24 hours without hemodynamic consequences. 3
59. Cahill AM, Baskin KM, Kaye RD, Fitz CR, Towbin RB. Transgluteal approach for draining pelvic fluid collections in pediatric patients. Radiology. 2005;234(3):893-898. Observational-Tx 51 patients To evaluate a transgluteal approach for draining pelvic fluid collections in pediatric patients. Transgluteal drainage was performed with computed tomographic (CT) guidance in 45 of the 53 collections (85%), with fluoroscopic guidance in three (6%), and with a combination of both modalities in five (9%). A drainage catheter was successfully placed in 49 collections; four small collections were aspirated without drain placement. Infected fluid was obtained from 41 collections, and serosanguineous fluid was obtained from 12 collections. The mean volume aspirated was 80 mL (2-600 mL). A positive culture was obtained at 28 of the 53 procedures. The mean duration of catheter placement was 4 days (range, 2-14 days). There were no major complications. 3
60. Harisinghani MG, Gervais DA, Maher MM, et al. Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology. 228(3):701-5, 2003 Sep. Observational-Tx 140 patients To assess the effectiveness of a computed tomographic (CT) image-guided transgluteal approach for percutaneous drainage of deep pelvic abscesses as an alternative to surgical drainage. The origins of the pelvic abscesses included postoperative fluid collection (n = 115), perforating appendicitis (n = 6), diverticulitis (n = 16), tubo-ovarian inflammation (n = 5), Crohn disease (n = 10), and internal bowel fistula due to irradiation (n = 2). The abscesses were 4-12 cm in diameter. The volume of the aspirate was 5-310 mL. Laboratory cultures of the aspirate grew mixed flora, but the organism most frequently isolated was Escherichia coli. Catheters were removed after a mean of 8 days. In 134 (96%) of 140 patients, there was complete resolution of the abscess following transgluteal drainage, without subsequent surgery. In six of 140 (4%) patients, incomplete resolution necessitated subsequent surgery for postoperative fluid collection (n = 3), diverticulitis (n = 2), or perforating appendicitis (n = 1). Complications of transgluteal drainage were rare and included hemorrhage in three (2%) of the 140 patients. There was no procedure-related mortality. A transpiriformis approach was significantly more likely to be associated with postprocedural pain (P <.001) than was an infrapiriformis approach. 2
61. Lee BC, McGahan JF, Bijan B. Single-step transvaginal aspiration and drainage for suspected pelvic abscesses refractory to antibiotic therapy. J Ultrasound Med. 2002;21(7):731-738. Review/Other-Dx 22 patients To evaluate the effectiveness and safety of US-guided transvaginal aspiration with the trocar technique in suspected pelvic abscesses that were refractory to antibiotic treatment. Transvaginal aspiration or drainage was successful in 19 (86%) of the 22 patients. Of the 3 patients in whom aspiration or drainage failed, all ultimately went on to have surgery despite undergoing repeated drainage procedures. Drainage catheters were placed in 15 (68%) of the 22 patients and left in place an average of 3.7 days. Aspiration alone resulted in a 100% success rate, whereas drainage with catheter placement resulted in an 80% success rate. No complications, including bleeding, bowel perforation, and death, were reported in any of the procedures. 4
62. Nelson AL, Sinow RM, Oliak D. Transrectal ultrasonographically guided drainage of gynecologic pelvic abscesses. Am J Obstet Gynecol. 2000;182(6):1382-1388. Review/Other-Tx 15 patients To assess the feasibility of US-guided transrectal aspiration of gynecologic pelvic abscesses to treat patients for whom IV antibiotic therapies failed and whose abscesses were not optimally amenable to colpotomy drainage or transabdominal or transvaginal US-guided aspiration. Purulent material was aspirated from the abscesses in 14 of the 15 women. All 14 women with aspirated material were successfully treated with real-time ultrasonographically guided transrectal drainage; only 4 of the 14 had indwelling catheter placement. 4
63. Sperling DC, Needleman L, Eschelman DJ, Hovsepian DM, Lev-Toaff AS. Deep pelvic abscesses: transperineal US-guided drainage. Radiology. 1998;208(1):111-115. Observational-Tx 11 patients To examine the efficacy of transperineal US-guided drainage of deep pelvic abscesses. Transperineal needle placement was successful in 12 of 12 patients (100%). In procedures that required catheter placement, 10 of 11 placements (91%) were achieved with the transperineal approach. One patient required fluoroscopic transvaginal catheter placement after opacification of the collection transperineally. Catheter drainage was maintained for 2-146 days (mean, 40 days; median, 21 days). Clinical success was achieved in nine of 10 patients (90%) by means of transperineal drainage. There were no complications, although premature catheter removal occurred in two patients. 3
64. Jaffe TA, Nelson RC, Delong DM, Paulson EK. Practice patterns in percutaneous image-guided intraabdominal abscess drainage: survey of academic and private practice centers. Radiology. 2004;233(3):750-756. Review/Other-Dx N/A To evaluate current practice patterns of percutaneous image-guided abdominal and pelvic abscess drainage in academic and private practice centers. 493 questionnaires were sent to 193 academic and 300 private practice radiology departments in the United States. Academic centers returned 95 questionnaires (49%), and private practice centers, 72 (24%). Percutaneous abscess drainage is performed by a fellowship-trained radiologist at 92 (97%) of 95 academic centers and 41 (79%) of 52 private practice centers (P < .001). Among 95 academic respondents and 52 private practice respondents, respectively, 56 (59%) and 33 (63%) do not perform drainage if an abscess has a diameter of less than 3 cm; 30 (32%) and nine (17%), if the white blood cell count is normal; and 16 (17%) and six (12%), if the patient is afebrile. Most (90 [95%] of 95 academic, 45 [87%] of 52 private practice) respondents use conscious sedation. A transabdominal approach and 8-12-F catheters are most frequently used by both groups. Academic respondents more frequently use transvaginal and transrectal approaches (54 [57%] and 51 [54%] of 95, vs 16 [31%] and 15 [29%] of 52 private practice respondents; P = .003) and 14-F catheters (69 [73%] of 95 vs 18 [35%] of 52; P < .001). 4
65. Puri R, Eloubeidi MA, Sud R, Kumar M, Jain P. Endoscopic ultrasound-guided drainage of pelvic abscess without fluoroscopy guidance. J Gastroenterol Hepatol. 2010;25(8):1416-1419. Review/Other-Tx 14 patients To evaluate the clinical efficacy of EUS-guided trans-rectal/transcolonic drainage of pelvic abscess without fluoroscopy. Fourteen consecutive patients were enrolled. EUS-guided aspiration was performed in three patients. In two patients, dilatation and aspiration was performed, while trans-rectal stent was placed in nine patients. All patients became afebrile within 72 h. Stent was removed in all patients, after confirming the resolution of the abscess on repeat computed tomography after 7 days. One patient in whom only aspiration was done had recurrence of fever and abscess on the seventh day and was treated by surgical drainage. A follow-up EUS done in 13 of the patients after 3 months revealed no recurrence, and all patients were asymptomatic at 6 months. The procedure was uneventful in all patients. 4
66. Garg CP, Vaidya BB, Chengalath MM. Efficacy of laparoscopy in complicated appendicitis. Int J Surg. 2009;7(3):250-252. Observational-Tx 110 consecutive patients To evaluate the efficacy of laparoscopic appendectomy in patients with complicated appendicitis. There were two conversions due to extremely friable appendix. Laparoscopic appendectomy took longer to perform (98 min versus 79 min) but was associated with less analgesic use, shorter median hospital stay (LA- 3 days; OA- 6 days, p<0.05), and lower rate of wound infections (LA, 8.2%; OA, 24.6 %, p<0.05). Intra-abdominal abscess occurred in four patients (8.2%) in LA group and fourteen patients (22.9%) in OA group (p<0.05). More patients in OA group experienced prolonged ileus than LA group but the difference was statistically insignificant. All complications were managed conservatively and there was no mortality in either group. 2
67. Greenstein Y, Shah AJ, Vragovic O, et al. Tuboovarian abscess. Factors associated with operative intervention after failed antibiotic therapy. J Reprod Med. 58(3-4):101-6, 2013 Mar-Apr. Observational-Tx 163 patients To evaluate whether size of tuboovarian abscess (TOA) and other clinical characteristics were associated with the need for surgical intervention. A total of 163 patients with TOA were identified; 41 patients were excluded based on specific criteria. Of the remaining 122 women, 65.6% responded to antibiotic therapy, and 34.4% had surgery or ultrasound-guided drainage. Mean TOA size in the medical group was 4.4 cm as compared to 7.3 cm in the surgical group (p < 0.0001). Maximal leukocyte count, older age, and parity were associated with significantly higher risk of surgery. The significant univariate variables remained significant after multivariate analysis. ROC curve analysis revealed an excellent discrimination of the need for surgical treatment as predicted by TOA size, with increased likelihood of surgical or procedural intervention with increasing TOA size. 2
68. Levenson RB, Pearson KM, Saokar A, Lee SI, Mueller PR, Hahn PF. Image-guided drainage of tuboovarian abscesses of gastrointestinal or genitourinary origin: a retrospective analysis. J Vasc Interv Radiol. 2011;22(5):678-686. Observational-Tx 57 TOAs drained in 49 female patients To analyze the authors' success with image-guided drainage of tuboovarian abscesses (TOAs). Thirty-three (58%) TOAs were drained percutaneously using computed tomography guidance and 24 were ultrasound guided (21 transvaginally, three transabdominally). Fifty-three TOAs were drained with catheter placement, and four were drained with aspiration alone. Abscess etiologies include pelvic inflammatory disease (n = 21, 37%), gastrointestinal conditions related (n = 21, 37%), gynecologic surgery (n = 8, 14%), and other (12%). Image-guided drainage resolved TOAs without salpingo-oophorectomy in 74% of cases overall (42 of 57) and 88% (29 of 33) of gynecologic-related cases, including 95% (20 of 21) of pelvic inflammatory disease cases. Salpingo-oophorectomy was performed more often in gastrointestinal-related cases (10 of 21, 48%) than for all other causes (five of 36, 14%; P < .001), with concurrent bowel surgery performed in the majority of the gastrointestinal-related cases. Mean follow-up after image-guided drainage was 48 months (range, 1-113) in patients who did not have related surgery. In patients who underwent salpingo-oophorectomy, it was performed on average 2.2 months (range, 0.5-5) after initial drainage. Two minor complications occurred; both involved catheter transgression of the urinary bladder in patients with transvaginal ultrasound-guided drainages. The patients were successfully treated conservatively with Foley catheter bladder decompression, without prolonged hospitalization. 2
69. Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv. 2009;64(10):681-689. Review/Other-Tx N/A To study management options for patients with tubo-ovarian abscess (TOA), and to compare rates of responders, pregnancies and complications associated with each management option. If intra-abdominal rupture is suspected, and patients are treated with fertility-preserving, conservative surgery, reported pregnancy rate is 25%. If no rupture is suspected and patients are treated with medical management alone, reported pregnancy rates vary between 4% and 15%. If no rupture is suspected, and the treatment is medical management with immediate laparoscopic drainage within 24 hours, reported pregnancy rates vary between 32% and 63%. Laparoscopy should be considered to all patients with TOA who desire future conception. 4
70. Gjelland K, Granberg S, Kiserud T, Wentzel-Larsen T, Ekerhovd E. Pregnancies following ultrasound-guided drainage of tubo-ovarian abscess. Fertil Steril. 2012;98(1):136-140. Observational-Tx 100 women To study fertility among women treated by means of ultrasound-guided drainage and antibiotics for tubo-ovarian abscess (TOA). Twenty of 38 (52.6%; 95% CI 36.5-68.9%) women who intended to have a child achieved pregnancy naturally and became mothers. In addition, 7 (50%) of 14 women who were not on birth control on a regular basis became pregnant. No ectopic pregnancies were registered. 2
71. Chou YH, Tiu CM, Liu JY, et al. Prostatic abscess: transrectal color Doppler ultrasonic diagnosis and minimally invasive therapeutic management. Ultrasound Med Biol. 2004;30(6):719-724. Review/Other-Dx 13 patients To analyze the transrectal ultrasound (US), or TRUS, and color Doppler ultrasonography (CDU) findings and therapeutic strategies with TRUS-guided procedures in 13 patients with prostatic abscess. Aspiration was done for all 11 abscesses between 1 and 3 cm. A total of 4 larger abscesses (> 3.0 cm) were treated with aspiration or drainage using a 5-French pigtail catheter. No surgical drainage was performed. 4