Absess Intraperitoneal

Clinical Some abscesses develop spontaneously, although most are secondary to postoperative complications or spread from a source in an adjacent structure, such as diverticular disease, appendicitis, cholecystitis, and so on. Fluid collections communicating with bowel can become huge, and patients have few symptoms due to the internal drainage. At times an abscess and peritonitis coexist, and the initial inciting event is difficult to identify. gallstone falling into the peritoneal cavity during laparoscopic cholecystectomy may not be readily retrievable. Although many of these intraperitoneal gallstones are innocuous, they do serve as a potential nidus for abscess formation, with some of these abscesses manifesting years later. An occasional dropped appendicolith, occurring mostly during laparoscopic appendectomy, results in a similar finding. At times the specific etiology for such an abscess is uggested by CT or US.
This is radiology images of the Postoperative abscess extending from the left hemidiaphragm inferiorly into left lower quadrant (arrows), communicating with the stomach. Barium sulfate was the contrast material used; it does not affect abscess healing.

                   Computed tomography, US, MRI, or scintigraphy should detect and localize most intraabdominal abscesses, and most can then be drained percutaneously, generally under US guidance. Numerous comparison studies have shown CT and US accuracies of over 90% in detecting intraabdominal abscesses. Whether the greater resolution of CT or the greater portability of US determine the modality used, clinically the availability is the deciding factor.
A note about subphrenic abscesses. It is almost unheard of to have a subphrenic abscess without an associated pleural effusion. Even a chest radiograph should detect such an effusion, and the absence of effusion essentially excludes a subphrenic abscess. If imaging identifies a suspicious abscess beneath the right hemidiaphragm but no pleural effusion is detected, an intrahepatic rather than a subphrenic abscess is more likely. Gas in a fluid collection generally implies an abscess,but gas bubbles are also seen in retained surgical sponges even without an abscess. Large amounts of gas suggest bowel communication, a finding seen with other benign and malignant conditions.
                   Computed tomography of a typical abscess shows a fluid-filled structure surrounded by a contrast-enhancing rim. Such a finding is not limited to abscesses and is also seen with some necrotic tumors and other benign conditions such as a hematoma and various cystic structures. Also, not all abscesses have this appearance. Differentiation of an abscess and a benign fluid collection is difficult, especially if the wall is thick. Loculated fluid after abdominal surgery tends to develop primarily in the abdomen and after pelvic surgery loculated fluid is mostly in the pelvis, but this is of limited use in differentiating benign fluid from an abscess.
                  Abscesses are hypointense on T1- and hyperintense on T2-weighted MR images; about half are homogeneous in appearance. Gadoliniumenhanced T1-weighted fat-suppressed images identify abscesses as fluid collections surrounded by a contrast-enhancing rim. Gas within an abscess appears as a signal void on both T1- and T2-weighted images. Coronal and sagittal reconstruction aids in differentiating an abscess from bowel. Fluid layering occurs in some abscesses, with hypointense material, presumably representing protein, being dependent on T2-weighted images, and such a finding in the peritoneal cavity is strong presumptive evidence of an abscess. Overall, MR sensitivity in detecting abscesses is close to 100%. Scintigraphy detects most abdominal abscesses. Useful radiopharmaceuticals include gallium-67 citrate, indium-111 leukocytes, and Tc-99m leukocytes. A major limitation of Ga-67 citrate scintigraphy is the prolonged time required to perform the study.
Radiology images of the Left subphrenic abscess secondary to a perforated gastric fundal adenocarcinoma.The entire fundus is amputated by tumor and abscess (arrows). The study was performed primarily for unexplained weight loss.

                   Percutaneous abdominal abscess drainage is an established technique, and almost all welldefined unilocular abscesses can be successfully drained. A majority of abscesses are cured with initial drainage. Recurrent abscesses can be drained percutaneously in most patients and surgery avoided in about half. Complex abscesses consisting of loculated, poorly confined, or multiple abscesses or those associated with a fistula have a lower success rate and often require several drains. A single abscess is often drained using US guidance, but multiple abscesses are easier to drain with CT guidance.
                  Distinguishing an abscess from necrotic tissue can be difficult. At times aspirate cytology is helpful. Similar to surgical drainage, attempts to drain infected necrotic tumors percutaneously are rarely successful. Conversion to surgical drainage (and often associated resection) is required with the presence of unhealing abscesses or fistulas and bowel or pancreatic necrosis. Catheter-induced bleeding is an occasional complication requiring surgical correction.
               Crohn’s disease abscesses can be drained percutaneously using image guidance, and the patient is thus stabilized. These abscesses tend not to resolve completely, especially if they involve an enteric fistula. Some left subphrenic abscesses cannot be readily drained using a transabdominal approach, and a transpleural approach is necessary. At times a drainage catheter is inserted through the pleura. Regardless of catheter position, most abscesses are successfully drained, although a transpleural approach risks a pneumothorax, requiring its own therapy. Abscess drainage using a transrectal or transvaginal approach with a combination of endoluminal US and fluoroscopy for needle advancement, tract dilation, and catheter insertion, combined with appropriate antibiotics, is effective therapy for most pelvic abscesses. Patients undergoing transrectal aspiration or drainage have less procedure-related pain and catheter pain than those with a transvaginal approach. A viable option for some pelvic abscesses is US-guided transperineal catheter drainage.
                Pelvic abscesses are readily drained in children and adolescents. The average hospital stay for children after image-guided transrectal drainage of pelvic abscesses tends to be shorter than after open surgical drainage. Surgical drainage is associated with more complications than percutaneous drainage, but comparison studies often have a built-in bias against surgery—patients undergoing surgical drainage tend to be sicker.
Computed tomography–guided transgluteal percutaneous drainage of deep pelvic abscesses through the greater sciatic foramen is an option in both adults and children. A majority of vancomycin-resistant enterococcal abscesses can be drained percutaneously, although the rate of successful therapy is lower than with more conventional abscesses; at times drainage provides a first clue to the presence of vancomycin-resistant enterococci.

Artikel Terkait

Absess Intraperitoneal
4/ 5


Suka dengan artikel di atas? Silakan berlangganan gratis via email

This below all content of radiology information

Neuroradiology Musculoskeletal radiology MRI Musculoskeletal MRI Abnormal Mri Brain X-RAY differential diagnosis Head Neck Anatomy mnemonic CT Teleradiology Radiology News chest Radiology musculoskeletal salary pediatrics ultrasound ultrasound images job Brain tumour abdomen interventional radiology Apk Android CT Abdomen with contrast DAMS Imaging radiology ramblings residency c nature pediatric radiology random ramblings xray C T Radiology Top basics body imaging guide procedure web 2.0 Chest X Ray Interpretation Teleradiology Providers head and neck radiology video Fun Ultrasound Hepatitis b cancer chest radiology salary 1 CXR GenitoUrinary ORTHOPEDICS Sonographic Measurements Stroke dams md/ms coaching mammography radiology business tuberculosis BRAIN Clinicoradiological series FETUS GI radiology Gastrointestinal x ray Radiology 4 Radiology Conferences Radiology Images Telemedicine UPPER LIMPS Ultrasound in Emergencies dynamic MRI lifestyle radiology links renal case spine 3 tesla MRI Dams clinicoradiological series Entrepreneur Gastrointestinal Tract Images Literature Liver abscess ultrasound MD/MS coaching Radiology 40 Radiology Imaging Radiology Journal Radiology PDF Radiology mcqs Ultrasound Technique blog bone tumour cardiac CT career cerebral venous thrombosis chest xray d fracture gadolinium gastrointestinal genitourinary radiology hepatobiliary imaging lipoma medical blogs mri lower abdomen pelvis psychiatry radiation concern social networking technology training urogenital imaging weblog 3D CT Arachnoid cyst CT Cardiac Chest X Ray Diploma Guid Equipment Cost FDA Fibrous dysplasia Interventional Ultrasound Guiding Biopsi MDCT MR Pancreas MRI Vertebrae MRI Vertebrae lumbal MRI contrast MRS RTA Radiology Teaching resource TB Hip TECHNIQUE Tech Thorax X Ray Upper Ext aiims ankle sprain bowel cancer brain abscess case study computers and radiology contrast ependymoma epidermoid facebook guest post internet journal of radiology iphone kienbock disease liver liver segments ct locum tenens mri abdomen multislice CT pericallosal lipoma plain film teaching files private practice radiology humour shoulder arthrogram shoulder dislocation small bowel social media trigeminal neuralgia tuberous sclerosis venous x ray Vertebrae 3d printing 7 tesla MRI ACL reconstruction ACL tear ACLS AIIMS nov 2008 ALPSA lesion ANGIOGRAPHY ATFL B12 deficiency BLS BOLD Breast imaging Breast imaging Mammography CHF CT Paranasal CT Scanner Price CT angiography CT coronary angiography CT technology CV junction CXR teaching files Carcinoid Contrast Agent Creutzfeldt-Jakob Disease Dams MD/ms Dams grand rounds Diffusion weighted imaging Dysmenorrhea E E World Award 2011 EYE Embolization Imaging Entrepreneurship FMG India FMGE FNH Focal liver lesions ultrasound Focal nodular hyperplasia GBM GI Gall bladder Glioblastoma multiforme Glomus jugulare HEAD HEART HRCT HSG Head injury ICA dissection IRIA 2011 IUGR IVC filter Iliotibial Band Friction Syndrome Job Info Kidney Cancer LV thrombus Leptomeningeal cyst MAMOGRAPHY MCI Screening MD MPPG MR mammography MR urography MRA MRCP MRI Cervical MRI update MRI/PET MRV Mesenteric ischemia Middle East respiratory syndrome coronavirus (MERS-CoV) Motor neuron disease NECK Normal Liver US Oncology trial PDF Radiology PM and R Physician PNS Partial anomalous pulmonary venous drainage Persistent trigeminal artery Pg entrance Physiatrist Physiatry Physician Assistant Plastic Surgery Price MRI Machines 2017 Pulmonology Pulvinar sign Radiology Price List Radiology Today Radiology Updates Radiology grandrounds Radiology images of GI Tract Renal Ultrasound Retinal Surgery Rheumatology Ryles tube SKULL Seizure Sellar Masses Sleep Medicine Sports Medicine Subdural hematoma Surgery TBM TRIANGULAR FIBROCARTILAGE COMPLEX Trauma Surgery URI Ultrasound HIV Umbilical vein Update Article Upper Extremity X Ray Urology Usmle VHL Vascular Surgery Veteran Affairs X Ray Head about accessory bone acute cerebillitis acute pancreatitis aiims may 2011 aipg ankle ankle fracture apple articular cartilage aspergilloma atherosclerosis avulsion injury awards bankart lesion basilar artery thrombosis bilateral phaeochromocytoma biopsy bipolar bohler's angle bone tumours brachial plexus brain tb brainstem stroke branchial cyst breast cancer screening buford complex business today calcaneal fracture calcium scoring canned reports carcinoma esophagus carcinoma stomach cardiac ct/pet cardiac pacemaker cardiogen 82 cardiothoracic imaging catrotid artery dissection cavernoma cervical lymphnode levels chest radiographic score chest radiographs choledocolithiasis classification cloud computing cochlear implant colloid cyst communication in radiology compare case concha bullosa congenital brain anomalies congenital heart disease coronary CT coronary artery disease corpus callosum agenesis craniopharyngioma cryptococcal meningitis ct abdomen and pelvis cystic renal disease dams usmle dams visual treat deep brain stimulator dengue dengue hemorrhagic fever developmental dysplasia devices diagnostic imaging dialysis diffusion MR imaging diffusion tensor imaging diffusion tractography digital radiography distal facial neuroma dsa duplication gall bladder echinococcus echocardiography ectopic kidney elearning elevated diaphragm epilepsy esop facial neuroma fibular osteosarcoma functional mri gastrointenstinal tuberculosis germinoma gifts glioma google google plus gun shot injury haemangioblastoma health 2.0 healthcare consultancy hemangiblastoma hemophilia hippocampus hirayama disease hydatid cyst hypercoagulable hypoxic ischemic encephalopathy indian conferences inferior rectus anomaly infrared interior tomography interstitial lung disease intramedullary metastates intramedullary tuberculomas ipad ipad 2 jacoud's arthropathy kernohan's notch knee kohler's disease krukenberg tumour laceration leber's optic atrophy liver transplant lung contusion lymphatics macros marchifava bingami disease mastoiditis maxillary sinus mucocele medial malleolus ossicle medial tibial stress syndrome medical writting medicare medicolegal aspects of teleradiology migraine mortality motor area mri knee mri lumbal msk penang course mucinous cystadenoma multicentric Glioblastoma multiforme mycotic pseudoaneurysm of superficial temporal artery nephrogenic systemic fibrosis nephrology neurosurgery meets nonradiologist oesophagus olecranon spur online medical games open access opercular syndrome opinion orbit os odontoideum os radiale externum osirix osteochondritis osteochondroma osteoid osteoma outsourcing radiology ovarian tumour parameniscal cyst paranasal sinuses parotid vascular mass patellar sleeve avulsion fracture patent ductus arteriosus patent foramen ovale patient information pelvic MRI pericardial fat phaeochromocytoma pharmaceutical writting pineal tumour placenta accreta placenta increta placental insufficiency pneumococcal pneumonia polycystic kidney disease portal Hypertension posterior circulation stroke power point presentation primary complex protected health information pseudobulbar palsy pseudomyxoma peritonei publications pulmonary edema pulmonary embolism pulmonary tuberculosis rabbit ear sign rad radiographic deterioration pattern radiography radiolo radiologist blogs radiology city radiology debate radiology images of spleen radiology intervensional radiology learning radiology search engine radiology spotter radiology spotters radiolopolis raditudes rathke cleft cyst renal imaging renal sinus tumour right sided aortic arch robot round cell tumour sacral agenesis scaphoid fracture schatzki ring scientific content screening search engine secondaries secondary ossification centres silicosis social radiology soft tissue chondroma solitary pulmonary nodule spectroscopy spinal arachnoid cyst spinal cord tumours spinal osteochondroma spine tumour spinoglenoid cyst sternal tuberculosis stress fracture sacrum stroke mri sub-acute combined degeneration subclavian pseudoaneurysm subependymal giant cell astrocytoma sumer sethi swyer-james syndrome syringomyelia tb teaching video teleradiolo teleradiology business models teleradproviders teleultrasound temporal bone fracture tendoachilles testicular tumour tethered cord. MRI tibial stress fracture total knee arthroplasty total shoulder replacment trachea. tracheal diverticulum tracheal stenosis tracheomalacia traumatic lung cyst triceps tear triquetral fracture tubercular abscess tuberculoma tuberculosis elbow ultrasound image of The segments of the liver umblical artery doppler uroradiology vascular malformation vasovist venous angioma ventriculitis video ct scan video mri viral encephalitis vitamin deficiency