CT-Guided Transhepatic Catheter Drainage of Deep Postoperative Collections: Initial Experience

Introduction 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. Materials and 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.

A prospective study of outcome of double pigtail catheter drainage in the management of breast abscess: analysis of outcome

Background: Breast abscesses, localized collection of pus in the breast, are most common in young lactating women. Traditional treatment of breast abscesses is by surgical incision, digital disruption of septa, evacuation of contents with occasional placement of surgical drains, and administration of systemic antibiotics. Percutaneous large-bore needle aspiration with or without ultrasound guidance is generally employed as the first line treatment of breast abscesses. It is generally done for medium to large sized unilateral abscesses and requires repeated aspirations for complete resolution of the abscess cavity.Methods: We have conducted this prospective study at SMIMER Hospital, Surat, Gujarat, India from January 2020 to January 2021. After ethical approval a group of 25 patients with unilateral breast abscesses irrespective of the lactational status were treated by percutaneous double catheter drains inserted under ultrasound guidance under the effect of local anaesthesia and evaluated for 3 months.Results: The resultant cosmetic effect was good, with no reported recurrence on 3 month follow-up.Conclusions: Double pigtail catheter drainage in appropriately selected cases of beast abscess has superior outcome in compare to published result of other technique for drainage of beast abscess specially in minimal scarring, early resolution of abscess cavity and decreases in the total duration of treatment.

Safety and Efficacy of Vacuum Bottle Plus Catheter for Drainage of Iatrogenic Pneumothorax

Iatrogenic pneumothorax is common after thoracic procedures. For pneumothorax larger than 15%, simple aspiration is suggested. This clinical trial (NCT03724721) assessed the safety and efficacy of vacuum bottle plus non-tunneled catheter air drainage, which has long been performed in many institutions. From August 2018 to February 2020, patients older than 20 years of age who developed iatrogenic pneumothorax were prospectively enrolled. Totally 21 patients underwent vacuum bottle plus catheter drainage. The median size of pneumothorax was 19.6%, as measured by Rhea’s method. Of the 21 patients, 15 had successful air drainage, and the remaining 6 patients required subsequent pigtail placement. The end-expiratory intrapleural pressure of all patients remained less than -20 cmH2O during drainage. The median duration of hospitalization was 2 (interquartile range [IQR], 1-4) days. No procedure-related complication was observed. A retrospective analysis of patients who received conservative treatment showed that the median duration of hospitalization was longer in patients with larger pneumothorax (1 day vs. 5 days [IQR, 1-1 day vs. 3-7 days]). This study showed that vacuum bottle plus catheter drainage of iatrogenic pneumothorax is a safe and efficient procedure. It is recommended as initial management of stable iatrogenic pneumothorax with size larger than 15%.

Nursing Research on Comprehensive Intervention of Pleural Reaction Undergoing Thoracentesis

Objective To explore the influence of different postures for pleural reaction in patients undergoing thoracic interventional operations. Methods The 695 patients with pleural effusion or hydro-pneumothorax underwent thoracic interventional operations (thoracentesis and thoracic catheter drainage) by ultrasound guidance from May, 2018 to February, 2021 were involved in this study. Two groups were divided in randomly，one was sitting posture group, 312 patients was preformed operations in this postures, the other group included 383 patients who were in supine or lateral positions. The pleural reaction rates of the two groups were compared. Results The pleural reaction rates were 18.5% (58/312) in sitting posture group and 2.8% (11/383) in supine group, there were statistically significant difference between the two groups. Conclusion Postures of patients can affect the occurrence of pleural reaction, supine position can reduce the incidence of pleural reaction.

Cerebral Air Embolism After Pigtail Catheter Drainage for Pneumothorax: A Case Report and Review of the Literature

Objective: Cerebral air embolism (CAE) is an extremely rare but serious complication of pigtail catheter drainage. The aim of the case report is to review our experience in the diagnosis and treatment for CAE after pigtail catheter drainage.Case presentation: In our study, we report a case of CAE following pigtail catheter insertion for pneumothorax. A 50-year-old man was diagnosed with a pulmonary mass in the right lower lobe. He underwent a right lower lobectomy. Pneumothorax was present after the removal of the chest tube. Pigtail catheter drainage was used in order to treat the pneumothorax, which resulted in convulsions, limb stiffness, and unconsciousness. A brain CT scan was immediately performed and showed multiple low densities in the right occipital lobe, which was diagnosed as CAE. Assisted breathing, antibiotic treatment, and antiepileptic therapy were used and the patient gradually improved and was discharged at 27 days of treatment but the muscle strength of the left limb was weakened.Conclusion: We analyzed and summarized the possible causes of CAE in the literature, and the findings of the case could enhance the vigilance of clinicians.