Cross Sectional Study of Pattern of Image Guided Percutaneous Abscess and Fluid Collections Aspiration and Drainage and Determinant of Successful Drainage at Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia from Hamle 2007ec - Meskerem 2013 Ec.
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Date
2020-09
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Addis Abeba University
Abstract
Introduction: Image guided percutaneous abscess and other fluid collection aspiration
drainage (PCD) is safe and cost effective means of draining an abscess. PCD is
noninvasive, has decreased procedure associated morbidly and mortality, reduced cost
of treatment and reduces length of hospital stay as compared to open surgical drainage.
The imaging modalities that can be used for drainage can either ultrasound or CT or
both of the modalities. The technique of drainage can be done by one of either trocar or
Seldinger technique based on the size of the abscess, depth from the skin surface and
absence or presence of intervening structures.
Objective: In this study assessment of pattern of image guided percutaneous fluid and
abscess aspiration and drainage and determinant of success of the procedure were
done.
Methods: Cross sectional prospective and retrospective study was employed from
September 2019 to September 2020GC. Cases of abscess collections were identified
from the US and CT log books as well as the computerized data bases of i-care from
Hamle 2007 to Meskerem 2020. The medical records of all patients with abscess or
fluid collection, who had undergone PCD in the study period, were studied. Data was
analyzed by using SPSS version 25.0 computer software. Then summarization and
comparison of data was done. Binary logistic regression analysis was used to identify
predictors of successful outcome following PCD.
Results: 59 patients were included in this study .The mean age of patients who
undergo PCD in this study is 43.58 with STD±15.6. Most of patients who undergo PCD
were male accounting 67.8 %( 40 patients) and came from urban areas accounting
58.3%. The most common site of abscess in this study was liver accounting 45%. In
37.3% of patients Seldinger technique and 32.2% trocar techniques were used for
catheter drainage of abscesses and fluid drainage. The mean amount of abscess
drained is 281 ml±47 Std initially in the procedure room. The majority of abscesses
drained had intermediate consistency 37.3% (22 abscesses drained).Microscopic
examination was done only on 22 patients (37.3 %) of the samples of abscesses
aspirated and drained. The most common microscopic finding that was confirmed was
pyogenic from different sites. The mean time taken to fully drain an abscess collection
or fluid collection was 5.714±6 Std days. The aspiration and drainage was successful in
55 patient accounting 93.2 %. The procedure had failed in four patients accounting
6.8%. Seven (11.9%) had major complications. Six developed recurrence and one had
pneumothorax. The only negative predictors of successful outcome was having
concomitant chronic illness (odds ratio [OR] = 0.006; 95% confidence interval [CI], 5.008-1.31;
P
=
.001).
Conclusions: The modality used to guide for abscess and fluid collection drainage is
usually depends on the site, loculation and radiologist preference. Successful PCD can
be done in almost every organs and spaces, with exception of intra-cranial collection,
which are even multiloculated and have thick echo debris on pre-procedure ultrasound.
The presence of chronic concomitant illness is one of the negative predictor of
successful drainage. Mere aspiration in small and multiple collections is as successful
as catheter drainage. PCD is proved to be safe and effective and has less morbidity and
mortality, avoid general anesthesia and complications related to laparotomy, less
numbers of days in the hospital and less cost compared to the surgical method of
drainage.
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Keywords
Ultrasound, CT, aspiration, catheter drainage, abscess and fluid collections