Related Experiment Video
Updated: Jun 14, 2025
Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
Minimally invasive video-assisted trans-diaphragmatic drainage of a subphrenic complicated abscess
Sabahattin Destek1, Osman Cemil Akdemir2, Ceren Gonultas3
1Department of Gastroentorology, Bezmiâlem Vakif University Medical Faculty Hospital, İstanbul-Türkiye.
Abstract:
Intra-abdominal abscesses usually originate from the gastrointestinal tract, with 70% occurring in the postoperative period. The mortality rate can reach 50%. These abscesses most commonly develop in the subphrenic and subhepatic spaces. Treatments include percutaneous drainage or surgical drainage. In this report, we present a minimally invasive video-assisted trans-diaphragmatic drainage (MIVTD) method through a simple incision using a right intercostal approach. This method was successfully performed on a patient who underwent Graham patch repair with laparotomy due to a diagnosis of peptic ulcer perforation and subsequently developed a right subphrenic multiloculated collection after unsuccessful percutaneous drainage.
Insights
Minimally invasive video-assisted trans-diaphragmatic drainage (MIVTD) offers a new approach for complex intra-abdominal abscesses. This technique successfully treated a challenging subphrenic abscess after failed percutaneous drainage.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Interventional Radiology
Background:
- Intra-abdominal abscesses are common, often post-surgical complications from the gastrointestinal tract.
- High mortality rates (up to 50%) necessitate effective treatment strategies.
- Subphrenic and subhepatic spaces are frequent locations for these abscesses.
Observation:
- A patient developed a right subphrenic multiloculated collection post-Graham patch repair and laparotomy.
- Previous percutaneous drainage attempts were unsuccessful.
- A minimally invasive video-assisted trans-diaphragmatic drainage (MIVTD) was considered.
Findings:
- MIVTD was successfully performed using a right intercostal approach through a small incision.
- This minimally invasive technique provided effective drainage for the complex abscess.
- The procedure was well-tolerated by the patient.
Implications:
- MIVTD represents a promising alternative for managing complex intra-abdominal abscesses, particularly when other methods fail.
- This approach may reduce patient morbidity associated with traditional surgical drainage.
- Further research into MIVTD for various abscess locations is warranted.
