Abscess-Fistula Complexes: A Systematic Approach for Percutaneous Catheter Management

David H. Ballard, Alireza Hamidian Jahromi, Anna Y. Li, Romulo Vea, Chaitanya Ahuja, Horacio B. D'Agostino

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10 Scopus citations

Abstract

Purpose To describe a systematic catheter management approach for treatment of abscesses with enteric fistulae by abscess evacuation and selective fistula tract cannulation in a series of patients with postprocedural abscess-fistula complexes. Materials and Methods This single-center retrospective study included 27 patients (17 male; mean age, 51.3 y) who underwent percutaneous drainage of postprocedural abscess-fistula complexes from January 2005 to September 2013. There were 15 low-output and 12 high-output fistulae. Intra-abdominal abscesses were evacuated by percutaneous drainage. Multiple catheters were used for collections with viscous fluid or size ≥ 6 cm in diameter. High-output fistulae and recurrent low-output fistulae had additional catheter cannulation of the enteric hole to facilitate the creation of a controlled enterocutaneous tract. There was no preexisting cutaneous tract before catheter insertion in 23 fistulae. Results Abscess-fistula complex resolution occurred in 24 patients (88.9%). Of the 3 cases of failure, 2 patients required surgical repair of the fistula, and 1 patient died. Mean number of drainage procedures was 7.0, and mean catheter duration was 76.1 days. There was no significant difference in catheter duration of low-output and high-output abscess-fistula complexes (P =.34); however, high-output patients underwent significantly more procedures (9.1 vs 6.1, P =.025). There were 15 fistulae that were cannulated (11 high-output and 4 low-output fistulae). Cannulated abscess-fistula complexes had significantly longer catheter duration (102.5 d vs 53.2 d, P =.04) and underwent significantly more procedures (8.4 vs 5.4, P =.04). Conclusions The catheter management strategy was successful in resolving most abscess-fistula complexes in this series.

Original languageEnglish
Article number3504
Pages (from-to)1363-1367
Number of pages5
JournalJournal of Vascular and Interventional Radiology
Volume26
Issue number9
DOIs
StatePublished - Sep 1 2015

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