The online version of this article (doi:10.1186/s12893-015-0030-4) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
DMA: performed the retrospective patient chart studies, literature search, drafted the manuscript and video; JWT: participated in the design, coordination; MFR: participated in the design, coordination; NRJ: participated in the design, interpretation of data; ETK: participated in the design, interpretation of data; RPM: radiology database analysis, imaging selection, coordination; KFSO: design of the study, coordination; JTK: design of the study, drafted the manuscript, case review, literature search. All authors read and approved the final manuscript.
Percutaneous drainage of infected intraabdominal fluid collections is preferred over surgical drainage due to lower morbidity and costs. However, it can be a challenging procedure and catheter insertion carries the potential to contaminate the pleural space from the abdomen. This retrospective analysis demonstrates the clinical and radiographic correlation between percutaneous drainage of infected intraabdominal collections and the development of iatrogenic pleural space infections.
A retrospective single institution analysis of 550 consecutive percutaneous drainage procedures for intraabdominal fluid collections was performed over 24 months. Patient charts and imaging were reviewed with regard to pleural space infections that were attributed to percutaneous drain placements. Institutional review board approval was obtained for conduct of the study.
6/550 (1.1%) patients developed iatrogenic pleural space infections after percutaneous drainage of intraabdominal fluid collections. All 6 patients presented with respiratory symptoms and required pleural space drainage (either by needle aspiration or chest tube placement), 2 received intrapleural fibrinolytic therapy and 1 patient had to undergo surgical drainage. Pleural effusion cultures revealed same bacteria in both intraabdominal and pleural fluid in 3 (50%) cases. A video with a dynamic radiographic sequence demonstrating the contamination of the pleural space from percutaneous drainage of an infected intraabdominal collection is included.
Iatrogenic pleural space infections after percutaneous drainage of intraabdominal fluid collections occur at a low incidence, but the pleural empyema can be progressive requiring prompt chest tube drainage, intrapleural fibrinolytic therapy or even surgery. Expertise in intraabdominal drain placements, awareness and early recognition of this complication is critical to minimize incidence, morbidity and mortality in these patients.
Davies CW, Gleeson FV, Davies RJ. BTS guidelines for the management of pleural infection. Thorax. 2003;58 Suppl 2:2:ii18–28.
- Pleural space infections after image-guided percutaneous drainage of infected intraabdominal fluid collections: a retrospective single institution analysis
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Jennifer W Toth
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Niraj J Gusani
Eric T Kimchi
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Jussuf T Kaifi
- BioMed Central
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