Percutaneous Drainage Techniques for Abdominal and Pelvic Abscesses

Percutaneous drainage has evolved into a cornerstone of management for abdominal and pelvic abscesses, offering a minimally invasive alternative to open surgery. Under imaging guidance, typically ultrasound or computed tomography (CT), a needle is introduced into the abscess cavity and a catheter advanced to evacuate purulent material. Two principal insertion techniques are employed: the Seldinger method, which uses a guidewire to facilitate catheter placement, and the trocar technique, in which the catheter is advanced directly over a stiff needle. Catheter selection is informed by the expected viscosity of the fluid, patient anatomy and the route of access, with common approaches including transhepatic, transgluteal, presacral and transperineal paths. Real-time imaging improves accuracy and reduces complications such as haemorrhage and organ injury. Drainage is often combined with antimicrobial therapy and may be supplemented by catheter flushing or upsizing to maintain patency. Over the last decade, refinements in low-dose imaging protocols, novel catheter materials and adjunctive techniques such as post-drain contrast injection have further optimised success rates. The global applicability of percutaneous drainage extends from high-resource tertiary centres to resource-limited settings, where dedicated training programmes have demonstrated feasibility and safety. As techniques and technologies continue to advance, percutaneous drainage remains integral to multidisciplinary care pathways for complex intra-abdominal infections.

Research from Nature Portfolio

Recent studies have provided quantitative data on fluid properties within abscess cavities, analysing the kinematic and dynamic viscosities of serous, purulent and biliary fluids. The findings reveal that purulent and biliary collections exhibit substantially higher viscosities than serous fluid, often requiring larger bore catheters to achieve efficient drainage. These reference values facilitate evidence-based decision making on catheter size and design, aiming to reduce clogging and procedural failure. This work also underscores the need for standardised viscosity assessments in device development and procedural planning, potentially streamlining drainage across diverse clinical settings.

Percutaneous Drainage Techniques for Abdominal and Pelvic Abscesses publication trend

The graph below shows the total number of articles in percutaneous drainage techniques for abdominal and pelvic abscesses across all publications each year (not limited to Nature Index journals).

Technical terms

Abscess: A localised collection of pus within body tissue, often presenting with pain, fever and inflammatory markers.

Percutaneous drainage: A minimally invasive technique to evacuate fluid collections using a needle and catheter under imaging guidance.

Computed tomography (CT) fluoroscopy: A real-time CT imaging modality that guides instrument placement during interventions while permitting rapid image updates.

Viscosity: A measure of a fluid’s resistance to flow; higher viscosity may necessitate larger drainage catheters.

French (F) scale: A unit of catheter diameter, where 1 French equals 0.33 mm; larger French sizes accommodate thicker fluids.

Contrast-enhanced drainography: The post-procedural injection of radiopaque dye through a drainage catheter to verify position, assess cavity resolution and detect residual collections.

References

1. Evaluation of viscosities of typical drainage fluids to promote more evidence-based catheter size selection. Scientific Reports (2023).
2. Low-Dose CT Fluoroscopy-Guided Drainage of Deep Pelvic Fluid Collections after Colorectal Cancer Surgery: Technical Success, Clinical Outcome and Safety in 40 Patients. Diagnostics (2023).
3. Comparative Analysis of Percutaneous Drainage versus Operative Drainage of Intra-Abdominal Abscesses in a Resource-Limited Setting: The Tanzanian Experience. Annals of Global Health (2023).
4. CT-guided special approaches of drainage for intraabdominal and pelvic abscesses. Medicine (2018).
5. Significance of Postprocedural Contrast Medium Injection after CT-Guided Abscess Drainage. Tomography (2023).