Kutsi KÖSEOGLU, Burak ÇILDAG, Hakan ERPEK, Ahmet DEMIRKIRAN

ZOR ERİŞİM YOLLU İNTRAABDOMİNAL APSELERDE BT EŞLİĞİNDE PERKUTAN DRENAJ

AMAÇ:Abdominal ve pelvik apselerin büyük bölümü kolay ulaşılabilir olmasına rağmen, bir kısım abdominalve pelvik koleksiyonlar ilk bakışta zor erişim yolu nedeni ile perkutan girişim için uygun görülmeyebilir. Buçalışmanın amacı zor erişim yoluna sahip intraabdominal apselerde BT kullanılarak yapılan perkutan drenajınetkinliğini değerlendirmekti.GEREÇ ve YÖNTEM:Zor erişim yollu abdominal apse veya koleksiyonu olan ve 2004-2008 yılları arasındaBT rehberliği kullanılarak perkutan drenaj yapılan 13 hasta retrospektif olarak değerlendirildi. Apse vekoleksiyonlar iki hastada karaciğerde, iki hastada dalakta, dört hastada perigastrik-subdiyafragmatik alan vesafra kesesi fossasında ve beş hastada pelvik bölgede yer almaktaydı. Klasik erişim yollarına ek olaraktranshepatik ve transgluteal gibi alternatif erişim yolları kullandık.BULGULAR:Perkutan drenaj kateterleri 12 hastaya Seldinger tekniği kullanılarak yerleştirildi. Bir hastadabaşta aspire edilen materyalin seröz olması nedeniyle drenaj kateteri yerleştirilmedi. Drenaj kateterleri drenajmateryali günlük 10cc altına azalana kadar koleksiyon bölgesinde tutuldu. Bu hastalardan drenaj kateteriyerleştirildikten iki gün sonra interloop apse nedeniyle operasyon geçiren bir hasta hariç diğer tüm hastalardabaşarıyla drenaj sağlandı.SONUÇ:Zor erişim yoluna sahip abdominal apselerde ek alternatif erişim yolları kullanılarak BT eşliğindebaşarıyla drenaj yapılabilir

Anahtar Kelimeler:

Abdominal apse, drenaj, tomografi

Percutaneous Drainage of Inaccessible Abdominal Abscess Using CT Guidance

OBJECTIVE: Although the majority of abdominal and pelvic abscesses can be drained through straightforward, a number of abscesses or fluid collections initially appear unsuitable for percutaneous drainage due to difficult access. The aim of this study is to evaluate the efficacy of percutaneous drainage using CT in intraabdominal abscesses, which have difficult access. MATERIALS and METHODS: We evaluated, retrospectively, 13 patients who had abdominal abscess or collection with difficult access and who underwent percutaneous drainage using CT guidance between 2004 and 2008. The abscesses and collections were localized in the liver in two patients, in the spleen in two patients, in the perigastric -subdiaphragmatic area and gallbladder fossa in four patients, and in the pelvic region in five patients. We used alternative drainage access such as transhepatic, transgluteal course in addition to conventional access routes. RESULTS: Percutaneous drainage catheters were placed using Seldinger technique into 12 patients. In one patient, the drainage catheter was not inserted because of initial aspirated material was serous. Drainage catheters were held in collection site until draining material reduced under 10cc daily. In these patients, collections successfully drained all of them but one whom underwent operation due to an interloop abscess two days after placement of drainage catheter. CONCLUSION: Abdominal abscesses which have difficult access can successfully be drained using additional alternative drainage routes byCTguidance.

Keywords:

Abdominal abscess drainage, tomography, spiral computed,

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