J Korean Soc Radiol.  2010 May;62(5):435-442. 10.3348/jksr.2010.62.5.435.

Usefulness of CT-Guided Percutaneous Catheter Drainage Using a Modified Version of the Seldinger Technique for the Treatment of Intra-abdominal Small Abscess and Poorly Depicted Fluid Collection on Sonogram

• Song CS

• KMID: 2002950
• DOI: http://doi.org/10.3348/jksr.2010.62.5.435

Abstract

PURPOSE
To evaluate the usefulness of CT-guided percutaneous catheter drainage (PCD) using a modified version of the Seldinger technique for deep-seated, small abscesses and poorly depicted fluid collection on abdominal sonogram.
MATERIALS AND METHODS
Fifty-nine cases of CT-guided PCD were performed on 56 patients. Four techniques were applied to secure safe access routes, which include scan postural change, angulation of the gantry, traversal of organs, and using a dissecting needle which can push the intervening bowel. Three landmarks (depth of the front and back wall of the fluid collection and the end point of catheter advancement over the guide wire) were indicated on the drainage catheter for extracorporeal direct observation of moving distance and location of the catheter during the insertion process. The technical success rate, clinical outcome, complications, and instrumental impairments were reviewed.
RESULTS
The technical success rate was 100% (59/59), and no grave complications occurred. Four cases (7%) of crooked guide wire insertion were noted. The clinical outcome revealed a 95% (56/59) successful treatment rate and a 5% (3/59) failed treatment rate, which was caused by undissolved hematoma (1/59) and fistula (2/59).
CONCLUSION
The results of this study suggest that CT-guided PCD using a modified version of the Seldinger technique for deep-seated, small abscesses and poorly depicted fluid collections on an abdominal sonogram is useful in terms of accuracy and safety.

MeSH Terms

Abdominal Abscess
Abscess
Catheters
Drainage
Fistula
Hematoma
Humans
Needles
Tomography, X-Ray Computed

Figure

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  Fig. 1 Steps of CT-guided catheter placement for deep-seated small fluid collection using modified Seldinger technique. A. Transverse CT scan shows an irregular small fluid collection along the pancreatic resection margin (arrow) in a 40-year-old woman who underwent distal pancreatectomy. Percutaneous catheter drainage was performed two days later. B. A precise puncture is made using an one-step access needle system (arrow) which is a safe and convenient tool for placing 18G cannula in the deep and small fluid collection. After removing inner fine needle, a guide wire with a floppy tip was placed in the fluid collection through the outer cannula. C. A schematic drawing of CT-guided placement of the drainage catheter using 3 points of landmarks indicated on the drainage catheter. Basically, three points F, B and S denote front wall and back wall of the fluid collection, and skin, respectively. Point F and B indicated on C2 status (insertion mode) connote the depth of the front and back wall of the fluid collection, respectively. Point S on C2 connotes the end point of catheter advancement over the guide wire, and the location of point S can be easily determined only in C1 status, that is, the distance from the deepest-placed portion of the curled pigtail catheter to the skin. So, during the catheter insertion, point F was used to recognize the catheter entering the front wall of the fluid collection, point B to stop advancing straightened catheter safely and to demount the catheter from the inner metal cannula correctly, and point S to finish catheter advancement over the guide wire precisely and expeditiously. D. A pigtail drainage catheter is correctly placed with a proper pigtail form in the fluid collection as designed on CT images.

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  Fig. 2 A 42-year-old man with multifocal infected fluid collections in the abdomen due to relapsing pancreatitis A. Transverse CT scan shows an irregular fluid collection (arrow) between the stomach and colon. No overtly safe access route was found on routine CT images. B. A dissecting needle system showing a stylet with a rounded tip. This needle has a special function to push intervening hollow viscera slightly. C. A dissecting needle (arrow) is applied to push the colon slightly and make a narrow safe access route. Once a safe access route is established, CT-guided drainage procedure can be correctly followed. D. A pigtail catheter (arrow) is safely and correctly placed in the fluid collection between the stomach and colon. Bowel perforation or pneumoperitoneum was not noted during and after the procedure.

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