Therapeutic Drainage
Predisposed Spaces for Collections
Infected collections, such as abscesses or infected bilomas, are known complications after upper abdominal surgery and require drainage by operative or radiologically guided drain placement. The right subphrenic space (1 ), left subphrenic space (2), Morison's pouch (3), left subhepatic space (4), and omental sac (5) are anatomic spaces that predispose to abscess development.
Catheters
The majority of postoperative collections in the upper abdomen are manageable by means of percutaneous drainage by interventional radiologic techniques using standard aseptic technique and local anesthesia. Thereby, collections are drained percutaneously under ultrasonographic or CT guidance using the Seldinger or trocar techniques. This figure illustrates a typical percutaneous drainage catheter, the MAC-LOC (A-1) that can be inserted by the introduction cannula (A-2) or the trocar stylet (A-3). The catheter has large, oval side ports to increase the drainage capability, as well as a radiopaque band that helps to identify the proximal area of the loop. This type of "self-locking" loop catheter has "memory," i.e., the loop at the end can be straightened during insertion by introducing a stylet intraluminally. After the catheter is positioned in place, the stylet is removed, and the loop reforms. This loop prevents displacement of the catheter.
Some fluid collections may require surgical drainage with repeated abdominal lavage and second-look procedures (Table3).
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