bda23054
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PRE-PROCEDURE DIAGNOSIS
Parasplenic abscess.
POST-PROCEDURE DIAGNOSIS
Parasplenic fluid collection.
NAME OF PROCEDURE
CT-guided percutaneous drainage of parasplenic fluid collection with placement of pigtail drain.
INDICATION
This is a 60-year-old male who is known to me for a gastric perforation, who is status post repair, status post leak. The patient has failed to thrive. A CT scan done recently showed multiple fluid collections, a large one in the posterior of the spleen with air fluid levels. He had had increasing white count and because of this it was decided to have a CT-guided drainage.
DESCRIPTION OF PROCEDURE
The patient was brought into the CT suite. A radiopaque marker was placed on the left flank near the suspected abscess. CT images were taken showing good visualization with radiopaque marker overlying the spleen. The skin was marked with skin marker and then prepped and draped in the usual fashion and injected with 1% lidocaine plain. The anesthetic needle was left in place to the planned trajectory of the drainage. CT scan images were then taken once again, verified proper trajectory and placement of the anesthetic needle. The anesthetic needle was then removed. A small skin nick incision was made using an 11 blade scalpel and a 5 French Yueh catheter was then inserted slowly with CT guidance into the fluid collection, aspirated. Appeared to be abscess but did not have a foul smell. May have been enteric contents or contrast from previous CT studies. It did flow without difficulty. Approximately 120 mL of purulent looking fluid were drained out. CT images were done again showing persistence of the fluid collection, so at this point it was decided to exchange the UE catheter for a pigtail drain. At this point a Cope guidewire was then placed through the Yueh catheter, the Yueh catheter was removed and then using a 5-French pigtail catheter was placed within the fluid collection under CT guidance. This was then sutured using a 3-0 silk and a dressing was placed and the skin was marked to verify that the drain was not pulled for the next few days. It was connected to a three-way stopcock and a Urocel bag. Drainage was excellent. CT scan images at the conclusion of the case showed perfect placement within the fluid collection.
The patient tolerated the procedure well and was wheeled back to his room in stable condition.
PRE-PROCEDURE DIAGNOSIS
Parasplenic abscess.
POST-PROCEDURE DIAGNOSIS
Parasplenic fluid collection.
NAME OF PROCEDURE
CT-guided percutaneous drainage of parasplenic fluid collection with placement of pigtail drain.
INDICATION
This is a 60-year-old male who is known to me for a gastric perforation, who is status post repair, status post leak. The patient has failed to thrive. A CT scan done recently showed multiple fluid collections, a large one in the posterior of the spleen with air fluid levels. He had had increasing white count and because of this it was decided to have a CT-guided drainage.
DESCRIPTION OF PROCEDURE
The patient was brought into the CT suite. A radiopaque marker was placed on the left flank near the suspected abscess. CT images were taken showing good visualization with radiopaque marker overlying the spleen. The skin was marked with skin marker and then prepped and draped in the usual fashion and injected with 1% lidocaine plain. The anesthetic needle was left in place to the planned trajectory of the drainage. CT scan images were then taken once again, verified proper trajectory and placement of the anesthetic needle. The anesthetic needle was then removed. A small skin nick incision was made using an 11 blade scalpel and a 5 French Yueh catheter was then inserted slowly with CT guidance into the fluid collection, aspirated. Appeared to be abscess but did not have a foul smell. May have been enteric contents or contrast from previous CT studies. It did flow without difficulty. Approximately 120 mL of purulent looking fluid were drained out. CT images were done again showing persistence of the fluid collection, so at this point it was decided to exchange the UE catheter for a pigtail drain. At this point a Cope guidewire was then placed through the Yueh catheter, the Yueh catheter was removed and then using a 5-French pigtail catheter was placed within the fluid collection under CT guidance. This was then sutured using a 3-0 silk and a dressing was placed and the skin was marked to verify that the drain was not pulled for the next few days. It was connected to a three-way stopcock and a Urocel bag. Drainage was excellent. CT scan images at the conclusion of the case showed perfect placement within the fluid collection.
The patient tolerated the procedure well and was wheeled back to his room in stable condition.