Drainage of abscesses and fluid collections

Almost any fluid collection Medical Tourism in India in the chest, abdomen or pelvis may be considered for percutaneous catheter drainage Medical Tourism, which has largely replaced surgery as the treatment of choice. Initially percutaneous drainage was confined to large superficial postopera-tive collections, but use has broadened to include complex multilocular collections, multiple abscesses and collections in difficult locations (e.g. presacral space, psoas muscle). CT or ultrasound is used to define a safe access route avoiding the penetration of major vessels or bowel. Ultrasound is adequate for superficial collections and may be preferable where an angled approach is required, e.g. sub-phrenic collections (Fig. 2.31). Superficial collections, where there is little risk of misdirection, may be safely drained via a simple one-step trochar catheter system. More complex or deep collections often require the more precise guidance of CT, using the needle guidewire and catheter exchange system originally devised by Seldinger for arterial puncture (Fig. 2.32). Diagnostic fine needle aspiration should be performed before drainage to determine the nature and viscosity of the collection. Nonviscous fluid — ascites, cysts, seromas, biliomas, urinomas — can be satisfactorily drained via an 8—10 French catheter. Thick, inspissated, infected material often requires a larger bore catheter (10—14 French) with multiple side holes and, ideally, a double lumen for cavity irrigation. At catheter insertion, the cavity should be evacuated as completely as possible. Saline irrigation may help to decrease the viscosity of the contents and encourage drainage. Patients should

be given broad-spectrum antibiotic cover before and after the procedure. Following catheter placement,

regular saline irrigation (10—20 ml tds) is important to maintain catheter patency. The catheter should be left in situ for several days until drainage ceases. Continued drainage of 50 ml or more suggests possible fistulous communication which may be confirmed by a contrast study via the catheter. Prolonged catheter drainage over several weeks may be necessary in such cases to allow fistulae to close. Successful catheter drainage of simple postoperative collections or localised abscesses can be achieved in over 90 per cent of cases. The t cure rate for more complex collections such as pancreatic abscesses, abscesses caused by leak from enteric, biliary or urinary anastomosis and thoracic empyaema is lower, between 70 and 85per cent. The multilocular nature of many of these collections makes complete evacuation difficult. However, in many patients percutaneous

drainage achieves palliation and allows the patient to undergo delayed, elective, single-stage surgery in a more stable condition with a relatively clean operative bed.

Hello this is Prince Mahajan and i am working in a medical company which is medical Tourism to India. and as working in a company i have given the task of uploading daily artcles.