NONOPERATIVE MANAGEMENT FOR INTRAABDOMINAL ABSCESSES

Percutaneous drainage of an intra-abdominal abscess is utilized freque ntly. To evaluate its effectiveness at our institution over 16 months, 18 patients (mean age 49 years) who underwent radiologically directed percutaneous drainage of intra-abdominal abscesses were retrospective ly reviewed. The abscesses were postoperative in 14 patients (laparoto my, 5; appendectomy, 4; colectomy, 3; hysterectomy, 2). Primary absces ses were due to diverticular disease (3), perforated appendicitis (3), perforated colon carcinoma (1), and perforated peptic ulcer (1). Perc utaneous drainage was ultimately established in all patients with comp lete resolution of the abscesses occurring in 12 patients (67%). The a verage duration for drainage was 5.5 days (range 1-23). Average length of hospital stay after the establishment of drainage was 14.6 days (r ange 1-48). Six patients required surgical procedures because of inade quate abscess drainage (4) or continued clinical deterioration (2). Th ere were no deaths. A major complication (colon perforation, enteric f istula) occurred in two patients (11%). Catheter-related problems were common (7/18 patients), and included drain migration (3), inadequate drainage (2), and catheter obstruction (2). Four patients required mul tiple percutaneous drainage procedures. Despite technical feasibility and clinical success in the majority of patients, percutaneous drainag e of these intraabdominal abscesses had frequent catheter-related comp lications. One-third of patients (31.8%) required surgical interventio n despite a prolonged period (average 15 days) of percutaneous drainag e. Patients demonstrated to have nonresolving abscesses by computed to mography (CT), abscesses associated with colonic diverticular disease or colon cancer, and abscesses localized to the left lower quadrant we re noted to have less successful percutaneous abscess drainage. Patien ts with a persistent or rising leukocyte count and/or an elevated APAC HE II score prior to drainage should be routinely reevaluated at 4 day s. Earlier surgical intervention is felt to be warranted because these two factors in this study were indicative of a low nonoperative succe ss rate. Post-appendectomy abscesses uniformly demonstrated prompt res ponse to percutaneous drainage. CT-directed percutaneous drainage of i ntraabdominal abscesses provides an alternative to immediate surgical intervention. The preliminary findings from this study suggest a limit ed application of this intervention in one-third of patients. Further detailed analysis of this patient group is required to delineate guide lines for identifying those patients where percutaneous drainage is un likely to be successful.