Outcomes and complications of ultrasound-guided percutaneous drainage of intra-abdominal abscesses at Moi Teaching and Referral Hospital

Abstract

Background: Intra-abdominal abscesses are a major contributor to morbidity and mortality around the world. More so in developing countries like Kenya where diagnosis and management are usually carried out late due to factors that include gender, level of education and long waiting time for specialized treatment. In the past and even currently, most of the Intra-abdominal abscesses (IAA) are treated via open surgery. However, with the age of Interventional Radiology, IAA are managed faster, and with better clinical and radiological outcomes. It is for these reasons that the role of Interventional Radiology needs to be assessed to see how better we can assist these patients. Objective: To determine the causative mechanisms of intra-abdominal abscesses, assess clinical and radiological outcomes of patients with IAA after percutaneous drainage and assess any complications that may arise from percutaneous drainage of IAA. Methods: This was a census, a prospective study conducted among 39 patients scheduled for percutaneous catheter drainage from January 2020 to December 2020. The study population was all patients who had confirmed intra-abdominal abscess in the outpatient department and in the medical and surgical wards, referred to the Interventional Radiology Department. A data collection form was used to record the demographics, causative mechanisms, radiological findings, microbiological features, clinical features and complication findings. The IAA were drained by the consultant radiologist under ultrasound guidance using a 3.5-5MHZ curvilinear transducer of Mindray M7. Data was extracted from the patients’ records and there after presented in form of tables, diagrams and prose. Results: The median age of patients was 40 (IQR 25, 48) years. The proportion of males was slightly higher (56.4%) compared to females (43.6%). Most (38.5%) of the IAA were complications following surgery; followed by trauma (25.6%) and cancer (23.1%). Majority (30.8%) of these IAA were in the right lower quadrant, sub-phrenic constituted 17.9% and psoas represented 12.8% of the sites. Out of the 39 patients included in the study, 28(71.8%) reported to have procedural complications. Of these 28, 26(92.9%) had minor complications that requires no therapy(Level A), 1(3.6%) had complications that resulted in hospitalization (Level C and D) while another 1(3.6%) had major complications that resulted in permanent change of the percutaneous catheter(Level E). Majority (88.5%) of those who had minor complication complained of pain, 1(3.8%) had a leak requiring no intervention while another 1 (3.8%) had fever post procedural. Conclusions: The most common causative mechanism of IAA was as complications following surgery. Clinically most of the patients complained of abdominal pains. Radiologically, majority of the IAA contained purely fluid material, had minimal inflammatory changes and showed free fluid surrounding them. Only 1 of the patients had a major complication. Recommendations: Clinical assessment of patients early; especially post-surgical patients to enable early detection of the IAA. Adequate post-procedural analgesia with counselling on the expected complications. Recommendations: Clinical assessment of patients early; especially post-surgical patients to enable early detection of the IAA. Adequate post procedural analgesia with counselling on the expected complications.