Guevara-Kissel Maria F, Egbuonu Kenechukwu, Valdivieso Sebastian, Gumbs Shamon, Murray-Ramcharan Max, Kissel Maxwell, Narayan Osti, Cadot Hadley
Department of Surgery, Harlem Hospital/Columbia University, New York, USA.
Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, USA.
Cureus. 2025 Jan 26;17(1):e78022. doi: 10.7759/cureus.78022. eCollection 2025 Jan.
Exploratory laparotomies for blunt or penetrating trauma often result in significant morbidity. Despite advancements in resuscitation, surgical techniques, and antibiotics, intra-abdominal abscesses remain a serious complication, contributing to poor outcomes and extended hospital stays. Percutaneous computed tomography-guided drainage is the standard treatment for abscesses, offering high success rates and low morbidity. However, its efficacy depends on factors such as abscess location and radiologist expertise. In cases where drainage is inaccessible, open or laparoscopic surgery may be required, which carries substantial risks. In rare situations, administering tissue plasminogen activator (tPA) via an abdominal drain has been shown to resolve abscesses effectively. This report discusses a 37-year-old male patient with a gunshot wound to the left upper abdomen, resulting in hemoperitoneum, gastric injury, and lacerations to the kidney and pancreas. Following surgical repair and placement of a Jackson-Pratt drain, the patient developed sepsis and a subphrenic abscess that could not be accessed for interventional radiology drainage. After weighing the risks and benefits, tPA was administered via the Jackson-Pratt drain, leading to clinical improvement. This innovative approach may offer an alternative for managing difficult-to-drain intra-abdominal collections, potentially reducing surgical intervention and associated morbidity. Currently, no large-scale studies or consensus exist regarding tPA use and dosing for abdominal collections, highlighting the need for further research. Insights from intrapleural tPA application could inform its broader use in intra-abdominal treatments.
因钝性或穿透性创伤而进行的剖腹探查术往往会导致显著的发病率。尽管在复苏、手术技术和抗生素方面取得了进展，但腹腔内脓肿仍然是一种严重的并发症，会导致不良后果并延长住院时间。经皮计算机断层扫描引导下引流是脓肿的标准治疗方法，成功率高且发病率低。然而，其疗效取决于脓肿位置和放射科医生的专业知识等因素。在无法进行引流的情况下，可能需要进行开放手术或腹腔镜手术，这存在很大风险。在罕见情况下，通过腹腔引流管给予组织纤溶酶原激活剂（tPA）已被证明可有效消除脓肿。本报告讨论了一名37岁男性患者，其左上腹遭受枪伤，导致腹腔积血、胃损伤以及肾脏和胰腺裂伤。在进行手术修复并放置杰克逊-普拉特引流管后，患者发生败血症和膈下脓肿，无法进行介入放射学引流。在权衡风险和益处后，通过杰克逊-普拉特引流管给予tPA，使患者临床症状改善。这种创新方法可能为处理难以引流的腹腔内积液提供一种替代方案，有可能减少手术干预及相关发病率。目前，关于tPA在腹腔积液中的使用和剂量尚无大规模研究或共识，这凸显了进一步研究的必要性。胸腔内应用tPA的见解可为其在腹腔内治疗中的更广泛应用提供参考。
