NON-VASCULAR INTERVENTIONAL RADIOLOGY (A THABET, SECTION EDITOR)
Drainage of Intra-abdominal Abscesses
Ronald S. Arellano
Published online: 25 May 2017
Springer International Publishing AG 2017
Purpose of Review This review focuses on the current man-
agement of intra-abdominal abscesses that arise from various
Recent Findings Advances in imaging and percutaneous tech-
niques now lead to image-guided percutaneous drainage as a
major factor for the management of intra-abdominal abscess-
es. In many cases, drainage combined with systemic antibiotic
therapy is often all that is necessary for abscess resolution.
Emerging surgical techniques now incorporate percutaneous
drainage procedures in a stepwise, methodical approach to
managing pancreatic necrosis.
Summary Image-guided intra-abdominal abscess are a fre-
quent clinical problem encountered in the trauma setting. In
most cases, image-guided percutaneous drainage plays a vital
role in managing.
Keywords Appendiceal abscess
Intra-abdominal collections are frequently encountered in pa-
tients with a variety of clinical scenarios, ranging from inflam-
matory processes in the abdomen and pelvis to postsurgical or
posttraumatic collections. Management of abdominal collec-
tions requires a multidisciplinary approach, with expertise
from infectious disease, surgery, and interventional radiology.
Image-guided percutaneous drainage has become the first
step in the management of many intra-abdominal collections.
For many patients, percutaneous drainage is favored over sur-
gical debridement as catheter drainage is often feasible in pa-
tients who are unsuitable surgical candidates. One of the ben-
efits of image-guided percutaneous drainage is that catheter
placement can be achieved with minimally invasive methods
that do not subject patients to the stresses of surgery.
The purpose of this article is to provide an update on the
role and methods of percutaneous drainage for the manage-
ment of intra-abdominal abscesses.
Surgery is the mainstay treatment for uncomplicated acute
appendicitis, both in children and in adults; however, surgical
management of appendiceal abscess and phlegmon is contro-
versial due to higher postoperative complications .
Conservative methods including image-guided percutane-
ous drainage in combination with antibiotic therapy with or
without interval appendectomy are alternatives for surgery
(Fig. 1). These methods are associated with decreased mor-
bidity, similar hospital stay, and risk of abscess recurrence
when compared with early surgery [2–5]. Conservative man-
agement also prevents the stress of surgery in critically ill
patients. In many cases, percutaneous drainage also avoids
unnecessary ileocecal resection and hemicolectomy that may
be necessary with resection in an acute setting; however,
drainage of an abscess is not always safe because of its
This article is part of the Topical Collection on Non-Vascular
* Ronald S. Arellano
Department of Radiology, Division of Interventional Radiology,
Massachusetts General Hospital, Harvard Medical School, 55 Street
Fruit, GRB 293, Boston, MA 02114, USA
Curr Trauma Rep (2017) 3:171–180