Management of postoperative intra-abdominal abscesses by routine percutaneous drainage

Postoperative intra-abdominal abscess (IAA) is a dreaded surgical complication. Percutaneous drainage (PD) has been offered as an alternative to surgical drainage for IAA because of the perceived lower morbidity and mortality rates. Seventeen consecutive unselected instances of IAA were reviewed to determine the value of the routine use of PD. Two patients with obvious anastomotic dehiscence and one with a retroperitoneal abscess were believed to be inappropriate for PD. Patients who could be managed by PD (group 1, n = 6) were similar to patients undergoing PD plus surgical drainage (group 2, n = 8) with respect to age, initial procedure, interval from operation to diagnosis of IAA and extent of organ failure. However, in group 2, more abscesses were greater than 5 centimeters (16.7 versus 62.5 percent), associated with polymicrobial growth (0.0 versus 50.0 percent), associated with enteric organisms (16.7 versus 100 percent; p < 0.05), accompanied by anastomotic dehiscence (16.7 versus 62.50 percent) and followed by a greater degree of mortality (16.7 versus 50 percent). Overall, only 33 percent of IAA were successful managed with PD alone. We conclude from these data that PD is of value only in selected instances of IAA. If an anastomotic dehiscence is a possibility, the patient should be managed operatively.