Patel Bhavik N, Morgan Madeline, Tyler Douglas, Paulson Erik, Jaffe Tracy A
Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC, 27710, USA.
University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
Abdom Imaging. 2015 Oct;40(8):3257-64. doi: 10.1007/s00261-015-0537-2.
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.
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.
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.
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.
本研究旨在描述我们在CT引导下经皮引流完全由气体构成的腹腔内局限性积液方面的经验。
进行一项经机构审查委员会批准的回顾性研究，分析8年间腹腔内仅含气体积液的患者。纳入7例接受经皮引流的患者。确定积液大小、随后液体的形成情况以及微生物培养结果。还分析了临床结局。
在2004年至2012年间转诊接受经皮引流的2835例患者中，7例患者（5例男性，2例女性；平均年龄63岁，范围54 - 85岁）符合纳入标准，CT显示腹腔内仅含气体积液。采用Seldinger技术进行经皮引流管置入（5根8F，1根10F，1根12F）。4例患者（57%）近期接受过手术（2例惠普尔手术，1例结肠切除术，1例肝切除术），而2例患者（29%）曾接受过远期手术（1例腹会阴联合切除术，1例乙状结肠切除术）。尽管最初的CT检查未发现可检测到的液体，但6例患者（86%）在引流时抽出了气体和液体，5例（83%）抽出物微生物培养呈阳性。4例患者（57%）在初次扫描时出现发热，所有这些患者抽出液培养均为阳性。4例患者（57%）有白细胞增多，所有这些患者抽出液培养均为阳性。
尽管腹腔内仅含气体积液且有感染迹象的患者相对少见，但应考虑对其进行与传统感染性液体积液类似的经皮处理。尽管CT上看不到液体，但这些积液可产生含有微生物的液体。
