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Purpose This article assesses the safety and utility of transhepatic drainage of deep seated postoperative intra-abdominal collections under computed tomography (CT) guidance in a short series. Methods This retrospective study included five patients (mean age: 45.8 years; 3 males, 2 females) who underwent CT-guided transhepatic drainage of postoperative abdominal abscess in our department between April 2019 and December 2020. The clinical and surgical details and the details of the transhepatic drainage procedure were evaluated along with success rates and complications. Results The surgical procedures were Whipple's pancreaticoduodenectomy in four patients and gastrectomy in one patient. Four out of five abscesses were drained through the right lobe of liver, while one was through the left lobe with a technical success rate of 100%. The mean total time for catheter drainage procedure including patient positioning and preparation was 29.2 minutes. None of the patients had procedure-related complications. Mean duration of catheter drainage was 12 days. All patients had complete resolution of symptoms after drainage and the clinical success rate was 100%. Conclusion Transhepatic approach is safe and effective for the drainage of inaccessible postoperative abdominal collections or abscesses where a standard percutaneous approach is not possible.

Background Fistulas are serious complications of splenic and perisplenic fluid accumulations, which are often difficult to detect by routine imaging methods. Purpose To evaluate the occurrence of spontaneous fistulas detectable during computed tomography-guided percutaneous drainage placement (CTGDP) with contrast filling of splenic or perisplenic fluid collections and to assess characteristics in comparison with perihepatic or peripancreatic fluid accumulations, also being treated with CTGDP. Material and Methods In 127 CTGDP-procedures, pre-interventional CTs conducted with intravenous contrast agent were compared to post-interventional CTs including contrast filling of the drain to identify spontaneous fistulas. Patient and case characteristics were evaluated, and therapeutic consequences of fistula identification were analyzed. Results A total of 43 perisplenic, 40 peripancreatic, and 44 perihepatic drains were evaluated; 13 (30.2%) perisplenic, 7 (17.5%) peripancreatic, and 10 (22.7%) perihepatic fistulas were observed. Concerning the frequency of fistulas, no significant difference was found between the patient groups ( P = 0.39). All fistulas were solely proven in CT scans including contrast filling of the drain. Seven fistulas (23.3%) required additional interventions. Perihepatic drains were significantly more often associated with recent surgery ( P Conclusion Spontaneous fistulas detected during CTGDP of splenic or perisplenic fluid collections are common. Post-interventional contrast filling of the drain drastically improves the detection rate of perisplenic, peripancreatic and perihepatic fistulas simultaneously initiating appropriate follow-up interventions.

Esophageal perforation with subsequent development of a mediastinal abscess is a well-known clinical entity. Etiologies including idiopathic and iatrogenic with invasive procedures have been reported in medical literatures. This condition is seriously associated with high co-morbidity and in some cases especially if intervention has not been applied associated with high mortality. For long time, open surgical intervention was the only available treatment modality for esophageal perforation with subsequent development of a mediastinal abscess. However, recently there are some other less invasive modalities that have been used with comparable if not preferable success including; self-expandable metallic or plastic stents and imaging guided percutaneous drainage of the mediastinal abscess combined with stenting. We report a patient who presented with esophageal perforation complicated with a mediastinal abscess that was treated successfully with an imaging guided percutaneous drainage of the mediastinal abscess. This case is to emphasize on the fact that endoscopic stent placement is safe and effective for esophageal perforations. Percutaneous CT-guided drainage of associated mediastinal abscesses is an uncommon procedure, but the results suggest that it is associated with high technical and clinical success rates. There should be increased involvement of interventional radiology in the management of those cases.

Amac: Bu calismada nefrostomi kateteri kullanilarak bilgisayarli tomografi (BT) esliginde yapilan perikardiyal efuzyonlarin drenajinin guvenliligi ve uygulanabilirligi degerlendirildi. Ca­lis­ma­pla­ni:­Aralik 2005 Kasim 2011 tarihleri arasinda klinigimizde 30 hastada (15 erkek, 15 kadin; ort. yas 52.3 yil, dagilim 18-80 yil) BT esliginde perikardiyal efuzyon drenaji gerceklestirildi. Yalnizca ekokardiyografi esliginde yapilan drenaj icin uygun olmayan hastalar secildi. Seldinger teknigi kullanilarak 8 veya 10F nefrostomi kateteri perikard bosluguna ilerletildi. Bul gu lar: Islem 29 hastada basarili idi. Bir hastada kateter perikard bosluguna yerlestirildi; ancak sivi aspire edilemedi. Bu hasta ameliyata alindi. Perikard boslugunda organize bir hematoma rastlandi. Ameliyat sirasinda sag ventrikulun anterolateral yuzeyinde kucuk bir epikardiyal lazerasyon tespit edildi. On iki hastada (%41) seroz sivi, 10 hastada (%35) hemorajik sivi, yedi hastada (%24) transud ve bir hastada (%3.3) purulan sivi aspire edildi. Ortalama 4±2 gun sonra kateterler cikarildi. Iki hastada (%6.6) perikardiyal efuzyon tekrarladi ve ayni yontemle basarili bir sekilde drene edildi. Yeni nuksler gozlenmedi. Isleme bagli olum gerceklesmedi. So­nuc:­ Calisma sonuclarimiz ekokardiyografi esliginde yapilan drenaj icin uygun olmayan hastalarda, nefrostomi kateteri ile BT esliginde yapilan drenajin etkili, guvenli ve uygun bir islem oldugunu gostermektedir. Bununla birlikte, bu teknigin ameliyat sonrasi lokalize perikardiyal efuzyonlu hastalar icin daha uygun oldugu gorusundeyiz. Anah tar soz cuk ler: Kardiyak tamponad; perikardiyal efuzyon; perikardiyosentez. Background:­ This study aims to evaluate the safety and feasibility of computed tomography (CT)-guided drainage of pericardial effusions by using a nephrostomy catheter. Methods: We performed CT-guided drainage of pericardial effusions on 30 patients (15 males, 15 females; mean age 52±3 years; range 18 to 80 years) in our clinic between December 2005 and November 2011. Only patients who were ineligible for echocardiography-guided drainage were selected. By using the Seldinger technique, a 8 or 10F nephrostomy catheter was inserted into the pericardial space. Results:­Procedure was successful in 29 patients. In one patient, the catheter was able to be placed in the pericardial space, but the fluid was unable to be aspirated. The patient was operated. An organized hematoma was found in the pericardial space. During surgery, a small epicardial laceration was detected on the anterolateral surface of the right ventricle. Serous fluid was aspirated from 12 patients (41%), hemorrhagic fluid from 10 patients (35%), transude from seven patients (24%) and purulent fluid was aspirated from one patient (3.3%). Catheters were removed after a mean duration of 4±2 days. In two (6.6%) patients pericardial effusion recurred and successful drainage was performed by the same method. No new recurrences were observed. No procedure-related death was occurred. Conclusion:­ Our study results suggest that CT-guided drainage with a nephrostomy catheter is an effective, safe and feasible procedure in patients who are ineligible for echocardiography-guided drainage. We also believe that this technique is more suitable for patients with postoperative localized pericardial effusions.

Image-guided percutaneous abscess drainage has become a standard method of treatment of most abdominal abscesses. In most cases, it should be considered the treatment of choice, but there are selected areas and circumstances that require specific approaches and methods. Typical abscesses within solid parenchyma organs or those in the peritoneal spaces can be reliably detected and efficiently drained. Abscesses that are multiple or long and circuitous require careful placement of catheters. Management of the drainage catheters includes irrigation with fluid to minimize accumulations of material that may impair egress of fluid. In selected cases, fibrinolytic agents have proved effective in shortening the drainage times and shortening hospital stays. Some controversial areas such as splenic abscesses, pancreatic abscesses, echinococcal abscesses, and fungal abscesses should only be attempted with careful selection and meticulous technique. Successful treatment is most likely with candid consultation among the various clinical services.

Sir, Image-guided percutaneous drainage is a minimal invasive method of treating collections and abscesses. We report a case of a patient with a small perineal abscess that extended into the corpus cavernosum. Conventionally, a corpus cavernosum abscess is surgically treated. In our opinion, it is important to have the best and least invasive treatment in these areas, as can be done with percutaneous drainage, to avoid extended tissue trauma and fibrosis.

Percutaneous drainage of abdominal and pelvic abscesses is a first-line alternative to surgery. Anterior and lateral approaches are limited by the presence of obstacles, such as the pelvic bones, bowel, bladder, and iliac vessels. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous, transgluteal approach by reviewing our clinical experience and the literature.We reviewed demographic, clinical and morphological data in the medical records of 30 patients having undergone percutaneous, computed tomography (CT)-guided, transgluteal drainage. In particular, we studied the duration of catheter drainage, the types of microorganisms in biological fluid cultures, complications related to procedures and the patient's short-term treatment outcome.From January 2005 to October 2011, 345 patients underwent CT-guided percutaneous drainage of pelvis abscesses in our institution. A transgluteal approach was adopted in 30 cases (10 women and 20 men; mean age: 52.6 [range 14-88]). The fluid collections were related to post-operative complications in 26 patients (86.7 %) and inflammatory or infectious intra-abdominal disease in the remaining 4 patients (acute diverticulitis: n = 2; appendicitis: n = 1; Crohn's disease: n = 1) (13.3 %). The mean duration of drainage was 8.7 days (range 3-33). Laboratory cultures were positive in 27 patients (90 %) and Escherichia coli was the most frequently present microorganism (in 77.8 % of the positive samples). A transpiriformis approach (n = 5) was more frequently associated with immediate procedural pain (n = 3). No major complications were observed, either during or after the transgluteal procedure. Drainage was successful in 29 patients (96.7 %). One patient died from massive, acute cerebral stroke 14 days after drainage.When an anterior approach is unfeasible, transgluteal, percutaneous, CT-guided drainage is a safe, well tolerated and effective procedure. Major complications are rare. This type of drainage is an alternative to surgery for the treatment of deep pelvic abscesses (especially for post-surgical collections).

Purpose To evaluate the role of image-guided percutaneous drainage in the management of post-hepatectomy perihepatic fluid collections. Materials and Methods An institutional database was used to retrospectively identify patients who underwent drainage for a post-hepatectomy peri-hepatic collection between 2007 and 2011. Medical records were reviewed to determine patient demographics, indications for surgery, imaging documentation of fluid collection(s), drainage procedure and follow-up. Technical success was defined as the successful placement of a drainage catheter within the fluid collection. Primary clinical success was defined as resolution of fluid collection by placement of drainage catheter. Secondary clinical success was defined as resolution of the peri-hepatic fluid collection after secondary manipulation of drainage catheter not requiring surgery. Results Between 2007 and 2011, 20 patients (M:F=12:8) with a mean age of 67 years (range: 49-80 years), underwent drainage of a post-hepatectomy peri-hepatic fluid collection. Sixteen patients (80%) underwent computed tomography guided drainage and 4 (20%) underwent ultrasound guided drainage. The mean collection size was 8.3 cm (range 2.2 cm -18 cm) and mean duration of catheter drainage was 26.5 days, (range 25- 89 days). Technical success was 100%, primary clinical success rate was 75 % (15/20) and the secondary clinical success rate was 20% (4/20) with an overall clinical success rate of 95%. One patient required surgical management of the collection for continuous high biliary output following successful catheter placement. None of the patients had procedure related complications. Conclusion Image-guided percutaneous catheter drainage of post-hepatectomy fluid collections is safe and effective procedure that is associated with high clinical success. Percutaneous drainage should be considered for the management of post-hepatectomy peri-hepatic collections.