Abdominopelvic Abscess / Collection Drainage

Background and indications

Image-guided percutaneous drainage of abdominal and pelvic abscesses and collections is a minimally invasive alternative to surgical drainage. It is first-line treatment for abdominal and pelvic collections > 3-5 cm accessible percutaneously: post-operative abscesses (anastomotic, wound), appendicular abscesses, diverticular abscesses, liver abscesses, infected collections or superinfected hematomas.

Pre-procedure assessment

Assessment includes contrast-enhanced abdomino-pelvic CT (location, size, accessibility, relationships with adjacent structures), infectious blood panel (CBC, CRP, blood cultures), and coagulation verification. A safe percutaneous path (without traversing hollow organs) is planned.

Procedure

Under local anesthesia (± sedation) and CT or ultrasound guidance, a pigtail drain (8-14F depending on collection viscosity) is inserted into the collection by Seldinger technique. Contents are aspirated (sample for culture and sensitivity). The drain is secured to skin and connected to gravity drainage. For deep pelvic collections, transgluteal or transrectal/transvaginal approach may be needed. The procedure takes 20-40 minutes.

Results and scientific evidence

Success rate (clinical and radiological resolution without surgery) is 80-90%. For post-appendectomy and post-diverticulitis abscesses, percutaneous drainage avoids surgery in most cases. Percutaneous drainage is as effective as surgical drainage with lower morbidity. If unsuccessful, salvage surgical drainage is performed.

Risks and complications

Drain displacement or obstruction (10-15%, repositionable), transient bacteremia (5-10%), hemorrhage (< 2%), organ perforation (< 1%). The drain may require daily flushing to maintain patency.

Recovery

The drain is maintained until clinical resolution and output < 10-20 mL/day (typically 5-14 days). Control CT before removal. Hospitalization varies by clinical context.

Practical information

The procedure is performed as an inpatient as part of infection treatment. It is performed by an interventional radiologist, in coordination with the surgeon and infectious disease specialist.