Abscess drainage

Ultrasound-guided drainage of abscesses is now the preferred treatment when the collection can be visualized on ultrasound and a safe route chosen. These may result from postoperative infection, inflammatory bowel conditions, such as Crohn’s disease or appendicitis, or other sources of infection, particularly in immunosuppressed patients. Drains come in different sizes and generally the thicker the pus, the larger the bore of drain that is required. Whilst aspiration is initially performed to confirm the nature of the collection, very often a drain is left in situ; together with appropriate antibiotic therapy this is usually effective. At the very least it normally leads to an improvement in the overall clinical condition to allow definitive treatment and can in itself be a definitive cure. Ultrasound is particularly useful in cases of hepatic abscesses and in draining the subphrenic, pericolic and subhepatic areas. Superficial collections, usually associated with wound sites, are also readily accessible to ultrasound. Collections obscured by bowel gas are best drained under CT guidance.
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