Paired Drainage Catheter Insertion: Feasibility of Placing Two Catheters within the Same Complex Abscess Cavity as a Primary and Salvage Percutaneous Drainage Technique

Abstract

Rationale and objectives: To assess the feasibility of paired catheter drainage for management of complex abdominal abscesses.

Materials and methods: This was a single-center retrospective study of 54 patients (35 males; mean age 48.9 years) that underwent paired catheter insertion for complex abdominal fluid collections in an 18-month period. Complex collections were defined as abscesses ≥6 cm in diameter with septations, high viscosity fluid or necrotic debris, or abscesses with an associated fistula. Abscess etiologies included postoperative (n = 28), pancreatitis (n = 12), perforated bowel (n = 7), liver abscess (n = 4), and perihepatic from gallbladder perforation (n = 3). Paired catheter insertion was defined two catheters co-located within one collection through the same skin incision or two closely spaced insertion sites. Paired catheter insertion was used primarily as initial drainage for complex intraabdominal abscesses and for salvage drainage in collections that could not be evacuated by a single catheter. Primary paired catheter insertion was used in 45 patients and as salvage in nine patients.

Results: Abscess resolution occurred in 51 (94.4%) patients. Patients had a median of three drainage procedures. Median duration of paired catheterization was 22 days. Seven abscesses recurred and all resolved with repeated drainage. Complications included one hemorrhage that was taken for surgical exploration. Overall, 48 patients had good clinical outcome, 3 patients died (multiorgan failure, n = 2; sepsis, n = 1), and 3 patients were lost to follow-up.

Conclusion: Percutaneous paired catheter drainage is a feasible technique for the treatment of both complex intraabdominal abscesses and abscesses unresponsive to single catheter drainage.

Keywords: Abdominal abscess; Abscess drainage; Drainage catheter; Image-guided percutaneous drainage; Intraabdominal abscess; Paired catheters.

Figure 1.

Insertion of paired catheters through a single incision (a) or multiple incisions (b). The authors prefer the latter when there is an adequate window.

Figure 1.

Insertion of paired catheters through a single incision (a) or multiple incisions (b). The authors prefer the latter when there is an adequate window.

Figure 2.

Illustrative diagram (a) of paired catheters in an intraabdominal abscess facilitating simultaneous irrigation and aspiration. Photograph (b) of the paired catheter technique being used for irrigation and aspiration.

Figure 2.

Illustrative diagram (a) of paired catheters in an intraabdominal abscess facilitating simultaneous irrigation and aspiration. Photograph (b) of the paired catheter technique being used for irrigation and aspiration.

Figure 3.

Illustrative case of salvage paired catheter drainage. A 39-year old female with necrotizing pancreatitis was diagnosed and drained with a single catheter at another center. She was transferred to our institution after sepsis persisted 7-days post single catheter insertion. CT upon arrival showed a large peripancreatic abscess (box) with a single 14-F catheter within the collection (arrows) (a). At drainage, the existing 14-F catheter was exchanged for two 20-F catheters (arrows and arrowheads) – over 1 L of pus was evacuated (b, c). The patient improved clinically, underwent two drainage revisions, and was subsequently discharged 18-days following the initial salvage paired catheter insertion.