David H Ballard1, Alireza Hamidian Jahromi2, Anna Y Li3, Romulo Vea4, Chaitanya Ahuja4, Horacio B D'Agostino4. 1. School of Medicine, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130. Electronic address: davidballardmd@gmail.com. 2. Department of Surgery Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130. 3. School of Medicine, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130. 4. Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71130.
Abstract
PURPOSE: To describe a systematic catheter management approach for treatment of abscesses with enteric fistulae by abscess evacuation and selective fistula tract cannulation in a series of patients with postprocedural abscess-fistula complexes. MATERIALS AND METHODS: This single-center retrospective study included 27 patients (17 male; mean age, 51.3 y) who underwent percutaneous drainage of postprocedural abscess-fistula complexes from January 2005 to September 2013. There were 15 low-output and 12 high-output fistulae. Intra-abdominal abscesses were evacuated by percutaneous drainage. Multiple catheters were used for collections with viscous fluid or size ≥ 6 cm in diameter. High-output fistulae and recurrent low-output fistulae had additional catheter cannulation of the enteric hole to facilitate the creation of a controlled enterocutaneous tract. There was no preexisting cutaneous tract before catheter insertion in 23 fistulae. RESULTS: Abscess-fistula complex resolution occurred in 24 patients (88.9%). Of the 3 cases of failure, 2 patients required surgical repair of the fistula, and 1 patient died. Mean number of drainage procedures was 7.0, and mean catheter duration was 76.1 days. There was no significant difference in catheter duration of low-output and high-output abscess-fistula complexes (P = .34); however, high-output patients underwent significantly more procedures (9.1 vs 6.1, P = .025). There were 15 fistulae that were cannulated (11 high-output and 4 low-output fistulae). Cannulated abscess-fistula complexes had significantly longer catheter duration (102.5 d vs 53.2 d, P = .04) and underwent significantly more procedures (8.4 vs 5.4, P = .04). CONCLUSIONS: The catheter management strategy was successful in resolving most abscess-fistula complexes in this series.
PURPOSE: To describe a systematic catheter management approach for treatment of abscesses with enteric fistulae by abscess evacuation and selective fistula tract cannulation in a series of patients with postprocedural abscess-fistula complexes. MATERIALS AND METHODS: This single-center retrospective study included 27 patients (17 male; mean age, 51.3 y) who underwent percutaneous drainage of postprocedural abscess-fistula complexes from January 2005 to September 2013. There were 15 low-output and 12 high-output fistulae. Intra-abdominal abscesses were evacuated by percutaneous drainage. Multiple catheters were used for collections with viscous fluid or size ≥ 6 cm in diameter. High-output fistulae and recurrent low-output fistulae had additional catheter cannulation of the enteric hole to facilitate the creation of a controlled enterocutaneous tract. There was no preexisting cutaneous tract before catheter insertion in 23 fistulae. RESULTS:Abscess-fistula complex resolution occurred in 24 patients (88.9%). Of the 3 cases of failure, 2 patients required surgical repair of the fistula, and 1 patient died. Mean number of drainage procedures was 7.0, and mean catheter duration was 76.1 days. There was no significant difference in catheter duration of low-output and high-output abscess-fistula complexes (P = .34); however, high-output patients underwent significantly more procedures (9.1 vs 6.1, P = .025). There were 15 fistulae that were cannulated (11 high-output and 4 low-output fistulae). Cannulated abscess-fistula complexes had significantly longer catheter duration (102.5 d vs 53.2 d, P = .04) and underwent significantly more procedures (8.4 vs 5.4, P = .04). CONCLUSIONS: The catheter management strategy was successful in resolving most abscess-fistula complexes in this series.
Authors: David H Ballard; Sarah T Flanagan; Ryan W Brown; Romulo Vea; Chaitanya Ahuja; Horacio B D'Agostino Journal: Acad Radiol Date: 2019-04-26 Impact factor: 3.173
Authors: David H Ballard; Abigail E M Erickson; Chaitanya Ahuja; Romulo Vea; Guillermo P Sangster; Horacio B D'Agostino Journal: Dig Dis Interv Date: 2018-06-08