Khurrum Baig M, Hua Zhao R, Batista O, Uriburu J P, Singh J J, Weiss E G, Nogueras J J, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston 33331, USA.
Tech Coloproctol. 2002 Dec;6(3):159-64. doi: 10.1007/s101510200036.
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.
腹腔内脓肿是消化道择期手术和急诊手术后发病率和死亡率的常见来源。CT引导下经皮穿刺引流腹腔内脓肿是立即进行手术干预的一种替代方法。我们研究了择期结直肠手术后发生腹腔内脓肿并接受经皮引流患者的临床特征和结局。我们回顾性确定了40例择期结直肠手术后发生腹腔内脓肿的患者，这些患者在1990年至1998年间接受了CT引导下经皮穿刺并用冯·索南伯格引流管进行引流。最常见的表现症状为发热39例（97%）、腹部压痛32例（80%）、肌紧张1例（2.5%）和腹部肿块3例（7.5%）；无患者发生弥漫性腹膜炎。最常见的索引手术是直肠结肠切除术加回肠肛管吻合术和回肠J袋，共12例（30%）患者。32例（80%）患者采用前路引流，8例（20%）患者采用经臀窗引流。35例（87.5%）患者有单个脓肿，2例（5.0%）患者有2个脓肿，3例（7.5%）患者有3个脓肿。13例（32.5%）患者围手术期使用了类固醇，30例（75%）患者术前使用了抗生素，40例（100%）患者术后使用了抗生素。平均35.8天的随访显示，26例（65%）患者脓肿完全消退；14例（35%）患者有残留或复发性脓肿，其中8例患者通过重复引流成功治疗，6例患者需要开腹手术。CT引导下经皮脓肿引流是治疗择期结直肠手术后腹腔内脓肿的有效方法。首次引流后主要成功率为65%，第二次引流后为85%。总之，对于无弥漫性腹膜炎体征的局限性腹腔内脓肿患者，应考虑将该技术作为首选治疗方法。
