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TRANSVAGINAL DRAINAGETubo-Ovarian Abscess

TRANSVAGINAL DRAINAGE

Needle Aspiration

Transvaginal DrainageTransvaginal Probe

Set Up

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Anatomic Issues

Bowel Vessels

Rectum Transgluteal

Collection

Transgluteal Drainage

Less complicated than you think

Less painful than you thinkAllows more options for

drainageUnderutilized

TRANSGLUTEAL Anatomic Consideratons

Sciatic

TRANSGLUTEALAvoid Bowel

Bowel

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Transgluteal Technique

Access route

chosenNeedle placed

LIVER ABSCESSAntibiotics Work

Pre Treatment Post Treatment

DIVERTICULITIS DIVERITICULITIS

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Elderly patient Pallaitive

Co-morbid disease Controversial

Appendiceal Drainage

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Left Subphrenic

Barium –6 weeks post drainage

CROHN’S DRAINAGE

CROHN’S DRAIANGE

No FistulaCROHN’S DISEASE

No Fistula

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Appendiceal Drainage

DIVERTICULITIS

Staging

DIVERTICULITISHealing Communication

Initial Injection

3 Weeks Later

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TROCAR TECHNIQUENot Always Easy CROHN’S DISEASE

DIVERTICULITISDifferential vs Tumor

Diverticulitis vs TumorCROHN’S DISEASE

Fistula with Colon

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CROHNSCommunication to Colon

DIVERTICULAR DRAINAGEWhy ?

1) Allow single stage surgery

2) Temporize ill patients

3) Downstage surgical stage

4) Does not preclude surgery

CROHN’S DRAINAGEWhy ?

1) Reduce operations

2) Make operations easier

3) Possible temporary cure

4) Fistulas common,but curable

Appendiceal Drainage

Pre-Irrigation Post-Irrigation

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Diverticular Abscess

Diverticular Abscess

One Week

What Access Route ?

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Diverticulitis vs Tumor Multiple AbscessesMultiple Approaches

Multiple Approaches Trocar Technique

Trocar TechniqueDIVERTICULITIS

Trocar Technique

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DIVERTICULITISFistula Connection Diverticulitis

1) Drainage palliative prior to surgery

2) Fistula to colon common 3) Patient –home with catheter4) Catheter may remain in for

weeks

Standard Abscess DrainageSTANDARD ABSCESS DRAINAGE

Routine Questions

Access route

Follow up – Clinical

Drainage over time

Fistula communication

Cure Expectations

Appendicitis Appendicitis

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Diverticulitis Diverticulitis

SUBPHRENIC ABSCESS2ND Manipulation

Value of 2nd

Manipulation

SUBPHRENICIncomplete Drainage

Tandem Technique

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SUBPHRENIC ABSCESSUS/Fluoro – Multihole Catheter

Subcostal

Large surface area

Subphrenic Abscess

Transgluteal Drainage Appendicitis

POST WHIPPLEAnastamotic Leak

No obstruction: Drain abscess and leak will close

Multiple CathetersMultiple Abscesses

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Multiple AbscessesMultiple Catheters

Infected HematomaWhy Failed Drainage?

CATHETER CHOICES

12 Fr

10 Fr

16 Fr

Trocar Technique

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Multiloculated Abscess

Whither Catheter Injection ?

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How do I tell that I have an abscess ?

SAFE ACCESS ROUTEWhere is the Bowel?

Where is the Bowel ? Identify the Bowel

Fistula Communicaton

Amount of drainage / Time

Character of drainage

Imaging shows no collection

Long term catheter drainage

Patience

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