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The inaccessible or undrainable abscess: how to drain it
Michael M Maher1, Debra A Gervais, Mannudeep K Kalra
1Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, White 270, 55 Fruit St, Boston, MA 02114, USA.
Summary
Percutaneous abscess drainage is effective for abdominal sepsis. Modified techniques enable drainage of even difficult-to-reach abscesses, potentially avoiding surgery.
Area of Science:
- Interventional Radiology
- Surgical Innovation
- Abdominal Sepsis Management
Background:
- Percutaneous abscess drainage is a standard treatment for abdominal and pelvic sepsis.
- Most abscesses are accessible for percutaneous drainage.
- Some collections present challenges due to location or content.
Purpose of the Study:
- To explore methods for draining abscesses initially deemed unsuitable for percutaneous drainage.
- To review alternative approaches and modifications for improved accessibility.
- To assess the feasibility of percutaneous drainage for complex intraabdominal abscesses.
Main Methods:
- Review of established alternative drainage routes (transgluteal, transvaginal, transrectal).
- Discussion of technique modifications including patient positioning and imaging hardware adjustments.
- Analysis of factors influencing accessibility of intraabdominal fluid collections.
Main Results:
- Alternative routes and positioning modifications can facilitate drainage of deep or inaccessible collections.
- Imaging hardware adjustments can enhance access to challenging abscesses.
- These techniques expand the applicability of percutaneous drainage.
Conclusions:
- Percutaneous drainage is a viable option for many complex abdominal abscesses.
- Modified techniques and alternative routes can avoid the need for exploratory laparotomy.
- Interventional radiology offers solutions for previously inaccessible intraabdominal sepsis.