title: Percutaneous postoperative intra-abdominal abscess drainage after elective colorectal surgery.
abstract: Intra-abdominal abscesses are a frequent source of morbidity and mortality following both elective and emergent surgery of the alimentary tract. CT-guided percutaneous drainage of intra-abdominal abscess is an alternative to immediate surgical intervention. We studied the clinical characteristics and outcomes of patients undergoing percutaneous drainage of intra-abdominal abscesses arising after elective colorectal procedures. We retrospectively identified 40 patients with postoperative intraabdominal abscess following elective colorectal surgery who underwent CT-guided percutaneous drainage with a Von Sonnenberg sump drain between 1990 and 1998. The most common presenting symptoms were pyrexia in 39 (97%), abdominal tenderness in 32 (80%), guarding in 1 (2.5%) and abdominal mass in 3 (7.5%); no patient had generalized peritonitis. The most common index procedure was proctocolectomy with ileoanal anastomosis and ileal Jpouch in 12 (30%) patients. Drainage was performed using an anterior approach in 32 (80%) and a transgluteal window in 8 (20%) patients. Thirty-five (87.5%) patients had a single collection, while 2 (5.0%) patients had 2 collections and 3 (7.5%) patients had 3 collections. Thirteen (32.5%) patients had perioperative steroids, 30 (75%) had preoperative antibiotics, and 40 (100%) had postoperative antibiotics. Follow-up at a mean of 35.8 days revealed complete resolution of abscess in 26 (65%) patients; 14 (35%) patients had residual or recurrent abscess successfully treated by repeat drainage in 8 patients and requiring laparotomy in 6. 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. In conclusion, this technique should be considered as the treatment of choice in patients with localized intra-abdominal abscess without signs of generalized peritonitis.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston 33331, USA.
authors.forename: M
authors.initials: M
authors.lastname: Khurrum Baig
authors.forename: R
authors.initials: R
authors.lastname: Hua Zhao
authors.forename: O
authors.initials: O
authors.lastname: Batista
authors.forename: J P
authors.initials: JP
authors.lastname: Uriburu
authors.forename: J J
authors.initials: JJ
authors.lastname: Singh
authors.forename: E G
authors.initials: EG
authors.lastname: Weiss
authors.forename: J J
authors.initials: JJ
authors.lastname: Nogueras
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D003106:Colon / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007410:Intestinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012007:Rectum / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed