# CT-guided pigtail removal and replacement



## bda23054 (Nov 16, 2012)

DATE OF OPERATION
10/22/12

PREOPERATIVE DIAGNOSIS
Peritoneal fluid collection.  

POSTOPERATIVE DIAGNOSIS
Ascites. 

NAME OF OPERATION
CT-guided pigtail removal and replacement.  

ANESTHESIA
Local.

WOUND CLASS
3 - contaminated.

BLOOD LOSS
0.

SPECIMEN REMOVED
Peritoneal ascitic fluid.  

INDICATIONS 
This is a 63-year-old male who was diagnosed with metastatic colon cancer.  He came in with abdominal pain.  A CT scan showed 2 distinct fluid collections.  He was previously treated at another facility and had had 2 pigtail drains placed within the peritoneal cavity and because of these 2 new discrete fluid collections, it was idealized that these fluid collections could be somewhat related to his pain, so the patient was brought in for re-CT evaluation and CT removal and replacement.  

DESCRIPTION OF OPERATION
The patient was brought to the CT suite, and placed in the left lateral wedge position.   CT scout films were done.  There was noted to be a large fluid collection that had now changed its appearance grossly under my best estimation as to be gross ascites within his peritoneal cavity.  My other concern was that the previously placed pigtail drain appeared to be crossing the pleural space into the peritoneal cavity.  So this was removed immediately and the patient was observed and noticed no shortness of breath.  CT scans were taken showing no pneumothorax.  At this point, where the previously placed drain was removed, an area inferior to it was prepped and draped in the usual sterile fashion, and anesthetized with 1% plain lidocaine.  An anesthetic needle was left in place and films were taken again noting proper trajectory into the planned fluid collection in the peritoneal cavity.  Using then a 7-French pigtail catheter, with the assistance of CT-guidance, was entered into the peritoneal cavity.  The catheter was then pigtailed within the space, again noting good placement under CT guidance and straw-colored fluid was copiously irrigated from the drain site.  This was then secured to a 3-way stopcock, a uroseal bag, and sutured with a 2-0 silk suture.  Op-Site dressing was placed.  The patient tolerated the procedure well. and was wheeled back to his room in stable condition.


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