Abscess drain migration into the colon following laparoscopic cholecystectomy

Abstract

Percutaneous abscess drainage is a procedure commonly performed by interventional radiologists to provide source control on infections using CT or ultrasound guidance. The interventionalist has many different sizes and shapes of catheters to treat abscesses of varying sizes and locations, but the general approach to each abscess is similar: provide a percutaneous route for purulence, bacteria, necrotic tissue, and other debris to escape the body. While generally considered a low-risk procedure, adverse events can occur due to operator error or other means. We present a unique case of an abscess drain placed into a right upper quadrant abscess that formed following laparoscopic cholecystectomy that perforated and entered the colon. Astute physicians, both in the emergency department and the radiology reading room, were able to rapidly rule out more common post-operative complications and make the correct diagnosis, likely preventing dangerous sequelae from developing in this patient.

Fig. 1

Axial CT angiogram of the abdomen in the arterial phase demonstrating large rim-enhancing fluid collection (blue arrow) in the right upper quadrant consistent with abscess. This collection abuts both the colon (yellow arrow) and duodenum (white arrow). There is no visualized site of bowel perforation, although this is not excluded.

Fig. 2

Axial non-contrast CT abdomen after treatment showing post-surgical changes of cholecystectomy and right upper quadrant abscess pigtail drain placement (blue arrow) with interval decreased size of the previously seen right upper quadrant abscess which closely abuts the hepatic flexure of the colon (yellow arrow).

Fig. 3

Coronal non-contrast CT abdomen showing abscess catheter within the colonic lumen (blue arrow) approximately 2 weeks after placement. Previously seen abscess is otherwise not well seen on this exam.