Percutaneous aspiration and drainage for suspected abdominal infection

Percutaneous drainage (PCD) of abdominal infection is a therapeutic modality whose role is not well defined. Surgical literature on abdominal infection cites a cumulative mortality rate in the range of 20% to 30%, markedly dissimilar from the 80% to 90% cure rates reported in the literature on PCD. We reviewed the PCD experience at a tertiary teaching hospital from 1981 to 1983. Fifty-five patients were suspected to have localized abdominal infection and underwent 66 procedures. PCD was attempted after percutaneous needle aspiration produced drainable fluid. Cure is defined by complete resolution of the abdominal process without any surgical intervention. Palliation is defined as acute decompression of the abdominal process permitting an elective corrective procedure to be performed. Failure is defined as false diagnosis, unsuccessful drainage requiring operation, or recurrence of infection. Diagnosis of the abdominal process was successfully made by aspiration in 59/66 (89%) attempts. PCD was curative in 31/66 (47%) attempts and failed or was palliative in 35/66 (53%). Simple nonfungal, nonfistulous abdominal abscesses were cured with PCD in 25/26 attempts (96%). PCD failure was encountered in 10 infected organized hematomas or thick phlegmons, nine fungal infections, nine abscesses with enteric communication, and five infected necrotic tumors. Abscesses with an underlying enteric communication were cured in 28%, were palliated in 32% and failed in 32% of PCD attempts. Abscesses with yeast as a major component or with necrotic tumor were never cured with PCD. PCD is a valuable diagnostic and therapeutic tool that is curative in simple abdominal abscesses. Its therapeutic role in complex abdominal infections seems to be limited.