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Title: A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses

Abstract

PurposeComputed 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.Materials and MethodsThis 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.ResultsAll 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 themore » patients.ConclusionsThe modified Trocar technique for percutaneous CT-guided drainage of abdominal abscesses may be feasible for lesions that are difficult to access with conventional methods.« less

Authors:
; ; ; ; ; ;  [1]; ;  [2];  [1]
  1. AC Camargo Cancer Center, Department of Imaging (Brazil)
  2. AC Camargo Cancer Center, Department of Abdominal Surgery (Brazil)
Publication Date:
OSTI Identifier:
22645212
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 40; Journal Issue: 5; Other Information: Copyright (c) 2017 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABSCESSES; COMPUTERIZED TOMOGRAPHY; FLUIDS; INJURIES; ORGANS; PATIENTS; PERITONEUM; POSITIONING; VASCULAR DISEASES

Citation Formats

Tyng, Chiang J., E-mail: chiangjengtyng@gmail.com, Amoedo, Maurício K., Bohrer, Yves, Bitencourt, Almir G. V., Barbosa, Paula N. V., Almeida, Maria Fernanda A., Zurstrassen, Charles E., Coimbra, Felipe J. F., Costa, Wilson L. da, and Chojniak, Rubens. A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses. United States: N. p., 2017. Web. doi:10.1007/S00270-017-1577-5.
Tyng, Chiang J., E-mail: chiangjengtyng@gmail.com, Amoedo, Maurício K., Bohrer, Yves, Bitencourt, Almir G. V., Barbosa, Paula N. V., Almeida, Maria Fernanda A., Zurstrassen, Charles E., Coimbra, Felipe J. F., Costa, Wilson L. da, & Chojniak, Rubens. A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses. United States. doi:10.1007/S00270-017-1577-5.
Tyng, Chiang J., E-mail: chiangjengtyng@gmail.com, Amoedo, Maurício K., Bohrer, Yves, Bitencourt, Almir G. V., Barbosa, Paula N. V., Almeida, Maria Fernanda A., Zurstrassen, Charles E., Coimbra, Felipe J. F., Costa, Wilson L. da, and Chojniak, Rubens. Mon . "A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses". United States. doi:10.1007/S00270-017-1577-5.
@article{osti_22645212,
title = {A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses},
author = {Tyng, Chiang J., E-mail: chiangjengtyng@gmail.com and Amoedo, Maurício K. and Bohrer, Yves and Bitencourt, Almir G. V. and Barbosa, Paula N. V. and Almeida, Maria Fernanda A. and Zurstrassen, Charles E. and Coimbra, Felipe J. F. and Costa, Wilson L. da and Chojniak, Rubens},
abstractNote = {PurposeComputed 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.Materials and MethodsThis 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.ResultsAll 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.ConclusionsThe modified Trocar technique for percutaneous CT-guided drainage of abdominal abscesses may be feasible for lesions that are difficult to access with conventional methods.},
doi = {10.1007/S00270-017-1577-5},
journal = {Cardiovascular and Interventional Radiology},
number = 5,
volume = 40,
place = {United States},
year = {Mon May 15 00:00:00 EDT 2017},
month = {Mon May 15 00:00:00 EDT 2017}
}
  • Purpose. To evaluate the effectiveness of CT-guided drainage of potentially life-threatening neck abscesses. Methods. Between September 2001 and December 2003, 15 patients presented to the emergency room with potentially life-threatening neck abscesses. Their clinical condition was critical due to the abscess size (larger than 3 cm in diameter; mean diameter 5.2 cm, SD 0.91 cm) and/or abscess location. A CT scan was carried out immediately to assess the lesion. At the same time, under CT guidance, an 8 Fr trocar-type pigtail catheter was inserted, in order to drain the abscess. The decision to drain percutaneously was based on a consensusmore » between the surgical, infectious disease and radiology teams. The catheter was kept in place until drainage stopped, and a follow-up scan was performed. Results. In 14 (93%) patients, the abscess was completely drained, and in 1 (7%) case the collection was still present because of multiple internal septation. That patient was treated by surgical management. The catheter was in place for a mean of 3 days (SD 0.96 day). Conclusion. Despite the fact that the number of our patients is small, CT-guided percutaneous drainage seems to be a fast, safe and highly effective low-cost method for the treatment of potentially life-threatening neck abscesses.« less
  • This study evaluated the safety, feasibility, and clinical utility of transhepatic drainage of inaccessible abdominal abscesses retrospectively under real-time computed tomographic (CT) guidance. For abdominal abscesses, 12 consecutive patients received percutaneous transhepatic drainage. Abscesses were considered inaccessible using the usual access route because they were surrounded by the liver and other organs. The maximum diameters of abscesses were 4.6-9.5 cm (mean, 6.7 {+-} 1.4 cm). An 8-Fr catheter was advanced into the abscess cavity through the liver parenchyma using real-time CT fluoroscopic guidance. Safety, feasibility, procedure time, and clinical utility were evaluated. Drainage catheters were placed with no complications inmore » abscess cavities through the liver parenchyma in all patients. The mean procedure time was 18.8 {+-} 9.2 min (range, 12-41 min). All abscesses were drained. They shrank immediately after catheter placement. In conclusions, this transhepatic approach under real-time CT fluoroscopic guidance is a safe, feasible, and useful technique for use of drainage of inaccessible abdominal abscesses.« less
  • A combination of computed tomography, ultrasonography, and fluoroscopy was utilized to guide percutaneous catheter drainage of 58 abscesses and fluid collections in 51 patients. Cavities were evacuated in 53 cases, with surgery avoided in 44 of these. There were two failures and six recurrences. The mean duration of catheter drainage was seven days. Five complications occurred, including a small bowel fistula and a lacerated mesenteric vessel. Based on this experience, guidelines for drainage are presented, as well as principles for the critical step of access route planning. Double-lumen sump drainage catheters and the irrigation procedure have simplified and improved drainage.more » Causes and solutions for unsatisfactory results are defined.« less
  • An indwelling drainage system for percutaneous drainage and radiotherapy of cystic craniopharyngiomas is described. The catheter is implanted into the cyst stereotaxically with a computed tomography-guided targeting device and connected to a Rickham reservoir. In addition to the repeated percutaneous evacuation of the cysts, this closed system enables intracavitary radiotherapy (yttrium-90) without the risk of leakage of the radioactive material into the cerebrospinal fluid spaces. The technique and relevant literature are discussed, and three typical cases are described.
  • A 66-year-old man underwent CT-guided drainage catheter placement within a pelvic abscess with a diameter of 46 mm. We performed the drainage by a transsacral approach because it was considered the safest and most feasible approach. An 8G bone marrow biopsy needle was used to penetrate the sacrum to create a path for subsequent drainage catheter insertion. After withdrawal of the biopsy needle, a 6 Fr catheter was advanced into the abscess cavity through the path using the Seldinger technique. Except for bearable pain, no procedure-related complications occurred. Twenty-nine days after the placement, the catheter was withdrawn safely and themore » abscess cavity had shrunk remarkably.« less