The role of CT-guided percutaneous drainage of loculated air collections: an institutional experience.
OBJECTIVE
The purpose of this study is to describe our experience with the role of CT-guided percutaneous drainage of loculated intra-abdominal collections consisting entirely of gas.


METHODS
An IRB-approved retrospective study analyzing patients with air-only intra-abdominal collections over an 8-year period was undertaken. Seven patients referred for percutaneous drainage were included. Size of collections, subsequent development of fluid, and microbiological yield were determined. Clinical outcome was also analyzed.


RESULTS
Out of 2835 patients referred for percutaneous drainage between 2004 and 2012, seven patients (5M, 2F; average age 63, range 54-85) met criteria for inclusion with CT showing air-only collections. Percutaneous drain placement (five 8 Fr, one 10 Fr, and one 12 Fr) using Seldinger technique was performed. Four patients (57%) had recently undergone surgery (2 Whipple, 1 colectomy, 1 hepatic resection) while two (29%) had a remote surgery (1 abdominoperineal resection, 1 sigmoidectomy). Despite the lack of detectable fluid on the original CT, 6 patients (86%) had air and fluid aspirated at drainage, 5 (83%) of the aspirates developed positive microbacterial cultures. Four patients (57%) presented with fever at the time of the initial scan, all of whom had positive cultures from aspirated fluid. Four patients (57%) had leukocytosis, all of whom had positive cultures from aspirated fluid.


CONCLUSIONS
Although relatively rare in occurrence, patients with air-only intra-abdominal collections with signs of infection should be considered for percutaneous management similar to that of conventional infected fluid collections. Although fluid is not visible on CT, these collections can produce fluid that contains organisms.
Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC, 27710, USA. bhavik.patel@dm.duke.edu.
Bhavik N
BN
Patel
University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
Madeline
M
Morgan
Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
Douglas
D
Tyler
Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC, 27710, USA.
Erik
E
Paulson
Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC, 27710, USA.
Tracy A
TA
Jaffe
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D057785:Catheters; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Air collection; CT; Percutaneous drainage