超声引导下腹部及盆腔脓肿引流

INTRODUCTION
Abdominal and pelvic abscesses are associated with considerable morbidity among the hospital population.1 Many cases resolve with antibiotics. However, some are complicated, leading to dissemination of infection with occasional fatal outcome. Antibiotic therapy is the mainstay. However, antibiotic therapy is not always successful because of resistant organisms and/or the presence of large-sized collections.2 Traditional surgical drainage has been the standard of care in managing these cases. However, surgical drainage has a high operative morbidity and the need for general anesthesia. The availability of minimally invasive image-guided percutaneous drainage has been a major breakthrough, with a lower morbidity and a lesser need for general anesthesia.2,3 This breakthrough has led to the
Ultrasound-Guided Abdominal and Pelvic Abscessห้องสมุดไป่ตู้Drainage
Harun Ozer, MDa,*, Wael E. Saad, MBBCh, FSIRb
KEYWORDS Ultrasound Abdominal abscess Pelvic abscess Drainage
Changes in the character of the drained fluid may be the first indication of a fistula, and further imaging may then be indicated.
Intrahepatic/parenchymal bile collections (especially after liver transplantation) should be interrogated with contrast and fluoroscopy to assess communication with the biliary tract for both diagnostic and therapeutic purposes.
Ultrasound Clin 7 (2012) 347–362 doi:10.1016/j.cult.2012.03.007 1556-858X/12/$ – see front matter Published by Elsevier Inc.
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Fig. 1. A 58-year-old man who developed recurrent right upper quadrant abscess extending into the right retroperitoneal space with a remote history of cholecystectomy. (A) Axial, (B) coronal and (C) sagittal contrastenhanced computed tomography (CT) images of the abdomen show a large, bilobed, peripherally enhancing perihepatic retroperitoneal collection (white asterisks) extending from the perihepatic region of the right upper quadrant along the right flank, involving the right paracolic gutter, posterior pararenal space, and lumbar musculature. (D) Transabdominal ultrasound image taken during drainage using the Seldinger technique showing catheter looped within the collection. Thick pus was aspirated and the catheter put to bag drainage. (E) Axial and (F) coronal contrast-enhanced CT images of the abdomen show almost complete resolution of the abscess and a small hyperdense focus (white arrow) within the residual abscess cavity at the tip of the liver suspicious for a retained stone. (G) Ultrasound shows a 1.3-cm shadowing round focus (between the calipers) within the chronic-appearing inflammatory collection suspicious for a retained gallstone.
INDICATIONS
An abscess is a localized collection of pus in a cavity formed by the disintegration of tissue. Pus is a thick, whitish-yellow fluid that results from the accumulation of white blood cells, liquefied tissue, and cellular debris. Most abscesses are formed by invasion of tissues by bacteria, but some are caused by fungi or protozoa, or even helminths. Other abscesses are sterile (no microorganism growth on cultures) and are mostly composed of tissue debris. Seventy-five percent of abdominal abscesses are nonvisceral (intraperitoneal or retroperitoneal) and 25% are visceral (hepatic, pancreatic, splenic, renal).5 There are several factors that predispose to the development of intra-abdominal abscesses. These factors include inflammatory/infectious diseases (cholecystitis, appendicitis, diverticulitis, pancreatitis, Crohn disease), abdominal surgery, abdominal cancer, trauma (blunt or penetrating trauma), and diseases associated with immunologic deficiency.
KEY POINTS
Ultrasound must be supplemented with fluoroscopy for guidance of catheter deployment if ultrasound depicts only part of an abscess or if more precise catheter positioning is required because of the proximity of adjacent structures. Fluoroscopy is useful to monitor wire manipulations in catheters placed with the Seldinger technique.
wider application of percutaneous drainage techniques, with their improvements to safety and efficacy, and has made percutaneous drainage the primary method of managing abscesses. This primary management can be definitive or as a prelude to a more planned and elective subsequent surgery (Fig. 1) that has a lower surgical morbidity and mortality.4