title: A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses.
abstract: OBJECTIVE
  Computed tomography (CT) is commonly used to guide drainage of deep-seated abdominal fluid collections. However, in some cases, these collections seem to be inaccessible due to surrounding organs or their being in difficult locations. The aim of this study is to describe a modified Trocar technique to drain collections in difficult locations, especially those in the subphrenic space, without passing through intervening organs.
  
  
  METHODS
  This retrospective case series study describes seven inpatients who underwent CT-guided drainage using a modified Trocar technique for abscesses that are difficult to access percutaneously. All patients provided written informed consent prior to the procedure. After placement of a 12-14F catheter inside the peritoneum, the Trocar stylet was removed so that the tip of the catheter became blunt and flexible to avoid injury to organs and structures in the catheter route, and the catheter was slowly advanced towards the collection using CT guidance and tactile sensation. After reaching the target, the stylet was reintroduced to enter the abscess wall.
  
  
  RESULTS
  All procedures were performed using an anterior abdominal wall access with adequate catheter positioning and resulted in clinical status improvement in the days after the drainage. No complications related to the procedure were identified in any of the patients.
  
  
  CONCLUSIONS
  The modified Trocar technique for percutaneous CT-guided drainage of abdominal abscesses may be feasible for lesions that are difficult to access with conventional methods.
authors.affiliation: Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil. chiangjengtyng@gmail.com.
authors.forename: Chiang J
authors.initials: CJ
authors.lastname: Tyng
authors.affiliation: Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil.
authors.forename: Maurício K
authors.initials: MK
authors.lastname: Amoedo
authors.affiliation: Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil.
authors.forename: Yves
authors.initials: Y
authors.lastname: Bohrer
authors.affiliation: Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil.
authors.forename: Almir G V
authors.initials: AG
authors.lastname: Bitencourt
authors.affiliation: Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil.
authors.forename: Paula N V
authors.initials: PN
authors.lastname: Barbosa
authors.affiliation: Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil.
authors.forename: Maria Fernanda A
authors.initials: MF
authors.lastname: Almeida
authors.affiliation: Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Zurstrassen
authors.affiliation: Department of Abdominal Surgery, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil.
authors.forename: Felipe J F
authors.initials: FJ
authors.lastname: Coimbra
authors.affiliation: Department of Abdominal Surgery, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil.
authors.forename: Wilson L
authors.initials: WL
authors.lastname: da Costa
authors.affiliation: Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil.
authors.forename: Rubens
authors.initials: R
authors.lastname: Chojniak
mesh_terms: D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000628:therapy*; D000328:Adult; D000368:Aged; D057785:Catheters; D004322:Drainage / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Abdominal abscess; Computed tomography; Percutaneous drainage