Медицинская литература. Новинки

 

 

 

 

 

 

Опыт малоинвазивного чрескожного лечения инфицированных жидкостных образований забрюшинного пространства сообщающихся с просветом толстой кишки

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Imaging Guided Percutaneous Treatment of Abdominal Infected Cystic Masses, Connected with Large Bowel

Purpose: Abdominal masses complicated with bowel fistula are not very uncommon, but sometimes are very difficult to diagnose and to manage. The experience of Low-Invasive Percutaneous Drainage (LIPD) of infected abdominal masses connected with large bowel is described. Material and Methods: LIPD as a treatment of ordinary infected cystic mass was performed to 3 patients. 2 of them underwent LIPD because of a left side retroperitoneal abscess. There was a postnephrectomy period in one case. In another case there was no previous surgery and retroperitoneal mass was due to infected sigmoid diverticulum. The third LIPD was performed to a septated cystic mass on the anterior aspect of pancreatic body and tail. This patient underwent the laparoscopic cholecystectomy, because of an acute cholecystitis and the mass was considered to be the infected pancreatic pseudocyst. All patients were symptomatic and were referred to imaging in order to find out the cause of manifested infection; the presence of connection with large bowel was unknown before LIPD. LIPD was performed under real-time Combined Ultrasound-Fluoroscopy Guidance using guide wire technique. 10 and 12 CH diameter ''Pig-Tail'' catheters were used. The presence of large bowel fistula was documented on fluoroscopy and CT using X-ray contrast injection into drained mass. Rinsing procedures using proteolytic enzyme injection was performed in all cases to achieve the adequate rinsing of septated masses with viscous content. As a gradual size reduction and content clean-up was achieved, sclerotherapy with alcohol was used in order to stick together the bowel fistula walls, what was documented by X-Ray contrast injection. Results: Positive result (recovery) was achieved in all cases.

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