One-step needle aspiration and lavage for the treatment of abdominal and pelvic abscesses.

Abstract

This retrospective study was undertaken to show the efficacy and safety of one-step needle aspiration and lavage for the treatment of nonenteric, nonpancreatic abdominal and pelvic abscesses. Eighty-two nonconsecutive patients (age range, 4-81 years old) with 97 abdominal and pelvic abscesses were treated over 16 years with a one-step percutaneous needle aspiration and lavage technique. Abscesses were drained with sonographic or CT guidance in a single session. An 18-gauge needle was used for aspiration and repeated saline lavage; no drainage catheter was left in place. For collections that appeared multiloculated, needle repositioning and repeated aspiration and lavage were performed during the single session. All patients received i.v. antibiotics. Eighty-seven (90%) of 97 abscesses in 72 of 82 patients were successfully treated, including 17 (85%) of 20 abscesses that were multiloculated. The only two complications were transient sepsis in one patient and hemorrhage in one patient that resolved with transfusion and conservative treatment. Needle aspiration and lavage failures were associated with diffuse peritonitis, occult malignancy, unsuspected enteric communication, and a dropped surgical clip. Percutaneous needle aspiration and lavage can be a safe, effective alternative to the more conventional treatment of prolonged catheter drainage. In selected patients, including certain patients with multiloculated abscesses, one-step needle aspiration and lavage should be considered as the initial method of treatment.