Ultrasound-guided Percutaneous Drainage of Intra-abdominal Collection and its Clinical Outcome: A Prospective Interventional Study

Abstract

Introduction: Intra-abdominal collections are abscesses that occur within the peritoneal cavity, the pelvis or behind the peritoneum (retroperitoneum) or intra-parenchymal. They are common complications of colorectal disease, particularly inflammatory bowel disease, malignancy and trauma. Ultrasound is very useful in establishing the diagnosis, quantification and localisation of intra-abdominal abscesses. Open Surgical Drainage (SD) used to be the traditional treatment protocol. Recently however, percutaneous drainage procedures are becoming an essential therapeutic strategy in the treatment of this condition. Aim: To study the therapeutic efficacy of ultrasound-guided drainage of abdominal abscess and to compare it with open SD. Materials and Methods: A prospective interventional study was conducted in 94 patients with intra-abdominal abscess at Gauhati Medical College and Hospital, Guwahati, Assam, India, in between July 2019 to June 2020 who were randomly allocated into two groups and underwent respective procedures. The first group was Percutaneous Catheter Drainage (PCD) and second group was open Surgical Drainage (SD) group. Patient demographics, symptoms, aetiologies and locations of the collections as well as duration of hospital stay, success rate, and complications were analysed. Results of radiological findings were tabulated, evaluated and collated between both the groups. Statistical Package for Social Sciences (SPSS) software 21.0 version was used for analysing data and p-value <0.05 was considered significant. Results: For abdominal collections and abscesses, ultrasound guided percutaneous drainage was successful in 96.8% of the patients whereas it was successful in 80% cases in the SD group. Complications were more frequently encountered in patients who underwent open SD (16.70%) compared to percutaneous drainage (12.40%) which was significant (p-value 0.0136). The average duration of stay for the group undergoing percutaneous drainage was 9.13±1.62 days which was shorter than for the group undergoing SD was 11.10±1.75 days (p-value <0.001). The overall rate of failed percutaneous drainage was 3.2% as compared to SD where it was 20%. Conclusion: This study concluded that image-guided percutaneous drainage has lesser complications and higher success rate for abdominal collections/abscesses as compared to SD. Due to lower mortality rates as well as shorter duration of hospitalisation than open SD it can replace the traditional open or laparoscopic approach of drainage in most cases.

Keywords

• abdominal abscess
• drainage methods
• intra-abdominal infections
• pigtail catheterisation
• postoperative complications
• ultrasonography