Complications related to percutaneous drainage

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Complications related to percutaneous drainage Percutaneous drainage procedures carry a risk of related significant complications of less than 10% (range 5-27%) depending on the underlying pathology and abscess location. These complications include bleeding, injury, erosion, transgression of small and large bowel, fistula formation, and others. Strategies to prevent these problems include correction of coagulation problems and determination of the exact etiology, location, and anatomic relationships of the abscess. Indication for percutaneous treatment of complex abscesses and patients with a persistent enteric leak should be reviewed critically, and operative treatment should not be delayed with lack of adequate patient improvement. Tertiary peritonitis Persistence of intra-abdominal infection (ie, tertiary peritonitis) is a complication that may occur following the treatment of primary or secondary peritonitis and peritoneal abscess. The details of this problem are described in the different sections of this article. 32
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Complications related to the open-abdomen technique One of the complications related to treatment of severe intra-abdominal infections with the open-abdomen technique and multiple reoperations is the development of enterocutaneous fistulae. A retrospective study to assess the results of open management of the abdomen in severe bacterial peritonitis after perforation or intestinal anastomotic disruption was performed in 67 patients. The mean number of reoperations required was 9. Fistula formation and severe bleeding occurred in 16 patients (24%). The in-hospital mortality rate was 42%. Long-term morbidity, particularly the number of abdominal wall defects, was considerable. A study of trauma patients found that morbidity due to wound complications (wound infections, abscess, and/or fistula) from the open abdomen remained high at 25%. Enterocutaneous fistulae can lead to ongoing (potentially large) volume, protein, and electrolyte losses; inability to use the gut for nutritional support; and associated long- term complications of intravenous alimentation. Patients with small, low-output, and distal fistulae often can be fed enterally with elemental diets. A proportion of these fistulae close spontaneously as the patient's overall status and nutritional status improve. High-output and proximal fistulae often require a delayed surgical repair. Optimal timing of this repair is critical. Initial inflammatory adhesions and dense scar formation may make safe reexploration impossible. Maturation of the scar tissue occurs over 6-12 months. Close observation of the patient's overall condition and nutritional status is important during that time. Deterioration of the patient's condition may force an earlier reoperation. For an extended time after operations for intra-abdominal infections, patients are at a several-fold increased risk of developing bowel obstruction related to intra-abdominal scar formation. While in some patients this obstruction may be partial and reversible and may improve with cessation of enteral intake and gastric decompression, most patients require reoperation over time.
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  • Winter '18
  • Jane doe
  • Sula, Peritoneum, peritoneal dialysis, Peritonitis

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