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Abdominal abscesses associated with enteric fistulas: percutaneous management
M R Schuster1, A B Crummy, M M Wojtowycz
1Department of Radiology, University of Wisconsin, Madison 53792.
Summary
Percutaneous drainage offers a safe and effective alternative to surgery for abdominal fistulas. This minimally invasive approach achieved high healing rates, potentially reducing hospital stays for patients.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Surgical Innovation
Background:
- Traditionally, abdominal fistulas required surgical excision.
- Percutaneous techniques have emerged as a viable alternative.
- Management of complex abdominal abscesses with fistulas presents challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous drainage for abdominal abscesses with fistulous communications.
- To assess the healing rates and complication profile of this minimally invasive approach.
- To explore the potential for outpatient management following percutaneous drainage.
Main Methods:
- Retrospective review of 150 consecutive abdominal abscesses drained percutaneously over 36 months.
- Identification of 26 fistulous communications in 24 patients (to bowel, pancreatic duct, or biliary system).
- Analysis of drainage duration, healing rates, complications, and management strategies (inpatient vs. outpatient).
Main Results:
- 88% (21 of 24) of fistulas healed without surgical intervention.
- Initial abscess drainage was performed in-hospital, with 17 patients managed as outpatients with a drainage tube.
- Complications were minimal, including two cases of tube dislodgement and one inadvertent colonic puncture.
Conclusions:
- Percutaneous drainage is a reliable and safe method for treating abdominal abscesses with fistulas.
- Outpatient management following percutaneous drainage can minimize hospital stay.
- Minimally invasive percutaneous techniques represent a significant advancement in managing abdominal fistulas.