MANAGEMENT OF LUNG ABSCESS WITH PERCUTANEOUS CATHETER DRAINAGE.
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ABSTRACT:
SUBMITTER: Prasad B
PROVIDER: S-EPMC5531321 | biostudies-other | 1998 Apr
REPOSITORIES: biostudies-other
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Project description:BackgroundLiver abscess is a life-threatening condition. Percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) are both minimally invasive techniques used to manage liver abscess. We aim to compare both techniques' efficacy and safety.MethodsWe performed a systematic review and meta-analysis involving randomized controlled trials (RCTs) from PubMed, Embase, Scopus, WOS, Cochrane, and Google scholar until July 22nd, 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol with ID: CRD42022348755.ResultsWe included 15 RCTs with 1,626 patients. Pooled RR favored PCD (RR: 1.21 with 95% CI: 1.11, 1.31, P<0.00001) in success rate and recurrence after six months (RR: 0.41 with 95% CI: 0.22, 0.79, P=0.007). We found no difference in adverse events (RR: 2.2 with 95% CI: 0.51, 9.54, P=0.29). Pooled MD favored PCD in time to clinical improvement (MD: -1.78 with 95% CI: -2.50, -1.06, P<0.00001), time to achieve 50% reduction (MD: -2.83 with 95% CI: -3.36, -2.30], P<0.00001) and duration of antibiotic needed (MD: -2.13 with 95% CI: -3.84, -0.42, P=0.01). We found no difference in the duration of hospitalization (MD: -0.72 with 95% CI: -1.48, 0.03, P=0.06). The results were heterogeneous for all the continuous outcomes which were all measured in days.ConclusionsOur updated meta-analysis concluded that PCD is more effective than PNA in liver abscess drainage. However, evidence is still uncertain, and more high-quality trials are still required to confirm our results.
| S-EPMC10061459 | biostudies-literature
Project description:PurposeAbscess is still a formidable disease and requires adequate drainage. Moreover, drainage in the head and neck area needs cosmetic care, especially in the pediatric population. In this report, we introduce our method of percutaneous abscess drainage using an indwelling needle cannula.Patients and methodsTen pediatric and five adult patients with cervical and/or facial abscess treated with this drainage method were retrospectively reviewed. Using an indwelling needle cannula (18-14 G Surflow®, Terumo, Tokyo, Japan), abscesses were penetrated under ultrasonic examination. Once purulent retention was identified, the inner metal needle was removed and the outer elastic needle was left and fixed. The outer needle was connected to the tube for continuous suction drainage for large abscess.ResultsThe primary diseases of these abscesses were cervical abscess of dental origin (5), purulent lymphadenitis (3), pyriform sinus fistula (2) and subperiosteal abscess due to mastoiditis (2), circumorbital cellulitis (1), infection of Warthin's tumor (1), and unknown origin (1). The median (range) duration of drainage was 4 days (3-9 days). Abscesses were successfully treated, and no patients required additional incision for abscess drainage. No apparent scars after drainage were observed.ConclusionThis technique resembles the usual venous placement of an indwelling needle cannula and is thought to be familiar to physicians. Although simple and inexpensive, this drainage is safe, effective, and minimally invasive for the treatment of abscess.
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Project description: Not available
| S-EPMC10812883 | biostudies-literature
Project description:Background: Splenic abscess (SA) is a rare, life-threatening illness that is generally treated with splenectomy. However, this is associated with high mortality and morbidity. Recently, percutaneous drainage (PD) has emerged as an alternative therapy in select patients. In this study, we compare mortality and complications in patients with SA treated with splenectomy versus PD. Patients and Methods: A systematic literature search of 13 databases and online search engines was conducted from 2019 to 2020. A bivariate generalized linear mixed model (BGLMM) was used to conduct a separate meta-analysis for both mortality and complications. We used the risk of bias in non-randomized studies of interventions (ROBINS-I) tool to evaluate risk of bias in non-randomized studies, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach for assessing quality of evidence and strength of recommendations. Results were presented according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: The review included 46 retrospective studies from 21 countries. For mortality rate, 27 studies compared splenectomy and PD whereas 10 used PD only and nine used splenectomy only. Data for major complications were available in 18 two-arm studies, seven single-arm studies with PD, and seven single-arm studies with splenectomy. Of a total of 589 patients, 288 were treated with splenectomy and 301 underwent PD. Mortality rate was 12% (95% confidence interval [CI], 8%-17%) in patients undergoing splenectomy compared with 8% (95% CI, 4%-13%) with PD. Complication rates were 26% (95% CI, 16%-37%) in the splenectomy group compared with 10% (95% CI, 4%-17%) in the PD group. Conclusions: Percutaneous drainage s associated with a trend toward lower complications and mortality rates compared with splenectomy in the treatment of SA, however, these findings were not statistically significant. Because of the heterogeneity of the data, further prospective studies are needed to draw definitive conclusions.
| S-EPMC9208856 | biostudies-literature
Project description:IntroductionIntra-abdominal abscesses complicating Crohn's disease (CD) present an additional challenge as their presence can contraindicate immunosuppressive treatment whilst emergency surgery is associated with high stoma rate and complications. Treatment options include a conservative approach, percutaneous drainage, and surgical intervention. The current multicentre study audited the short-term outcomes of patients who underwent preoperative radiological drainage of intra-abdominal abscesses up to 6 weeks prior to surgery for ileocolonic CD.MethodsThis is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing ileocolic resection for primary or recurrent CD from June 2018 to May 2019. The outcomes of patients who underwent radiological guided drainage prior to ileocolonic resection were compared to the patients who did not require preoperative drainage. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes.ResultsAmongst a group of 575 included patients who had an ileocolic resection for CD, there were 36 patients (6.2%) who underwent abscess drainage prior to surgery. Postoperative morbidity (44.4%) and anastomotic leak (11.1%) were significantly higher in the group of patients who underwent preoperative drainage.ConclusionsPatients with Crohn's disease who require preoperative radiological guided drainage of intra-abdominal abscesses are at increased risk of postoperative morbidity and septic complications following ileocaecal or re-do ileocolic resection.
| S-EPMC9167187 | biostudies-literature
Project description:Video 1Successful EUS-guided nasocavitary catheter drainage of abscess caused by delayed perforation after gastric endoscopic submucosal dissection.
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Project description:BackgroundAlthough percutaneous transthoracic catheter drainage (PCD) has been proven effective in lung abscesses, the optimal timing of PCD is still unclear. The study aimed to evaluate the safety and efficacy of early versus delayed drainage in patients with lung abscesses.MethodsThis retrospective study included 103 consecutive patients with liquefied lung abscesses more than 3 cm confirmed by a CT scan received CT-guided PCD over 16 years, from July 2005 to September 2021, in a single institution were reviewed. Early drainage was defined as PCD within one week after a lung abscess was diagnosed. The primary outcome was 90-day mortality. The secondary outcomes included perioperative complications and patients' length of hospital stay (LoS). Factors associated with 90-day mortality and LoS were also analyzed. The key statistical methods were Chi-square test, Fisher's exact test, Student t-test, and Pearson correlation.ResultsAmount the 103 patients, there were 64 patients who received early PCD, and 39 patients received delayed PCD. Between the two groups, there were no significant differences in clinical characteristics, 90-day mortality, or perioperative complications. The LoS was significantly shortened in early PCD group (28.6 ± 25.5 vs. 39.3 ± 26.8 (days), p = 0.045). Higher Charlson comorbidity index, secondary lung abscess, and liver cirrhosis were associated with higher mortality (all p < 0.05). Positive sputum culture significantly increased the LoS (coefficient 19.35 (10.19, 28.50), p < 0.001).ConclusionThe 90-day mortality and complications were similar for early PCD and delayed PCD patients, but LoS was significantly shortened in early PCD patient.
| S-EPMC10508285 | biostudies-literature
Project description:Introduction:Abdominal abscesses are one of the frequent and dangerous postoperative complication. They occur as a result of failure of seams esophagojejunal anastomosis after gastrectomy (17%), perforation of gastric and duodenal ulcers (26.8%), splenectomy (25.4%), failure of biliodigestive anastomoses (23.8%), inadequate drainage of the subphrenic space (22.2%), acute pancreatitis (14%). Left-sided subphrenic abscesses are the most common of them. Case presentation:We present a patient with the left-sided subphrenic abscess, formed as a result of insolvency of the esophagojejunal anastomosis after gastrectomy and splenectomy, which underwent percutaneous drainage under the control of ultrasound and X-ray. Sanitation of the abscess cavity and the introduction of fibrin glue into it made it possible to close the fistula and heal the patient. Discussion:The described case shows that the rehabilitation of the abscess and the injection of fibrin glue into it, made it possible to avoid surgery, eliminate the abscess and close the connection with the esophagojejunal anastomosis in a short time. Conclusion:Percutaneous drainage under the control of ultrasound made it possible to avoid surgery and heal the patient with the left-sided subphrenic abscess in a short time. Fistula treatment with fibrin glue is not only effective, but is also less risky than surgery.
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Project description:Infected aortic aneurysm (IAA) is a rare, life-threatening disease with rapid progression and a high mortality rate. An 84-year-old man developed IAA caused by urosepsis owing to extended-spectrum β-lactamase-producing Escherichia coli infection. Considering surgical risk and perioperative mortality, the patient underwent computed tomography-guided percutaneous abscess drainage and continuous irrigation with optimal antibiotic therapy. We controlled his systemic inflammation without surgery; thus, he was discharged. Six months later, we confirmed that the abscess had almost disappeared in the follow-up computed tomography scan. Percutaneous abscess drainage and irrigation may be an effective therapeutic option for surgical high-risk patients with IAA.
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Project description:Pleural effusion is an accumulation of fluid in the pleural space that is classified as transudate or exudate according to its composition and underlying pathophysiology. Empyema is defined by purulent fluid collection in the pleural space, which is most commonly caused by pneumonia. A lung abscess, on the other hand, is a parenchymal necrosis with confined cavitation that results from a pulmonary infection. Pleural effusion, empyema, and lung abscess are commonly encountered clinical problems that increase mortality. These conditions have traditionally been managed by antibiotics or surgical placement of a large drainage tube. However, as the efficacy of minimally invasive interventional procedures has been well established, image-guided small percutaneous drainage tubes have been considered as the mainstay of treatment for patients with pleural fluid collections or a lung abscess. In this article, the technical aspects of image-guided interventions, indications, expected benefits, and complications are discussed and the published literature is reviewed.
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