Do we always need a drainage catheter ?
男性，憩室炎，多发性肝脓肿
Multiple drainage catheters
• Multiple large bore punctures
• Need for multiple fluoro controls
• Patient’s discomfort (5 catheters)
Multiple punctures and aspiration
• Thick pus cannot be aspirated
• May persist if communicating with bile ducts
• Must be converted to PAD if unsuccessful
超声引导下，套管针吸，广谱抗生素 Cefotetan 4g，Metronidazole 2g/day 12天后
完全缓解
• Abscesses near the dome are challenging Frequently necessary to transgress pleura
• Trial of antibiotics can be successful.
• Consider US/Fluoro or CT + Gantry angulation
• Occasionally require multiple catheters.
• Bacteremia during/following procedure relatively common-pre-procedure antibiotics
• Communication with bile ducts -usually settles if no biliary obstruction-catheter usually stays in longer
Filice C, Pirole F, Foglieni CS Gastroenterology 1990; 98:1366
多发肝脓肿
比较
肝脓肿与胆道相同
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