title: Abscess-Fistula Complexes: A Systematic Approach for Percutaneous Catheter Management.
abstract: OBJECTIVE
  To describe a systematic catheter management approach for treatment of abscesses with enteric fistulae by abscess evacuation and selective fistula tract cannulation in a series of patients with postprocedural abscess-fistula complexes.
  
  
  METHODS
  This single-center retrospective study included 27 patients (17 male; mean age, 51.3 y) who underwent percutaneous drainage of postprocedural abscess-fistula complexes from January 2005 to September 2013. There were 15 low-output and 12 high-output fistulae. Intra-abdominal abscesses were evacuated by percutaneous drainage. Multiple catheters were used for collections with viscous fluid or size ≥ 6 cm in diameter. High-output fistulae and recurrent low-output fistulae had additional catheter cannulation of the enteric hole to facilitate the creation of a controlled enterocutaneous tract. There was no preexisting cutaneous tract before catheter insertion in 23 fistulae.
  
  
  RESULTS
  Abscess-fistula complex resolution occurred in 24 patients (88.9%). Of the 3 cases of failure, 2 patients required surgical repair of the fistula, and 1 patient died. Mean number of drainage procedures was 7.0, and mean catheter duration was 76.1 days. There was no significant difference in catheter duration of low-output and high-output abscess-fistula complexes (P = .34); however, high-output patients underwent significantly more procedures (9.1 vs 6.1, P = .025). There were 15 fistulae that were cannulated (11 high-output and 4 low-output fistulae). Cannulated abscess-fistula complexes had significantly longer catheter duration (102.5 d vs 53.2 d, P = .04) and underwent significantly more procedures (8.4 vs 5.4, P = .04).
  
  
  CONCLUSIONS
  The catheter management strategy was successful in resolving most abscess-fistula complexes in this series.
authors: School of Medicine, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130. Electronic address: davidballardmd@gmail.com.
authors: David H
authors: DH
authors: Ballard
authors: Department of Surgery Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130.
authors: Alireza
authors: A
authors: Hamidian Jahromi
authors: School of Medicine, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130.
authors: Anna Y
authors: AY
authors: Li
authors: Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130.
authors: Romulo
authors: R
authors: Vea
authors: Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130.
authors: Chaitanya
authors: C
authors: Ahuja
authors: Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130.
authors: Horacio B
authors: HB
authors: D'Agostino
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology* / Q000601:surgery*; D000465:Algorithms; D002404:Catheterization / Q000379:methods*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome