Wounds International, Vol 1, Issue 5Practice Draining postoperative abdominal abscesses through a trocar

Draining postoperative abdominal abscesses through a trocar

15/11/10 | Complex wounds, Infection | Jianan Ren, Guoshen Gu, Jun Chen, Yaoping Fan, Jieshou Li

Draining postoperative abdominal abscesses through a trocarAbdominal abscesses that develop as a result of surgery can cause deep space surgical site infection (SSI). These abscesses are usually drained by percutaneous abscess drainage (PAD), however the draining tube can become blocked by necrotic tissue and blood coagulates. Similarly, sump drainage requires a laparotomy for placement. This short report details how the authors developed a method of sump drainage using a 12mm trocar.


The authors' hospital is a national referral centre for patients with gastrointestinal fistula. A common complication is postoperative intra-abdominal abscess, which can be a cause of deep space surgical site infection (SSI). Most are treated using percutaneous abscess drainage (PAD) because it is a minimally invasive and causes fewer metabolic, immune function and organ function disturbances compared to treatments involving laparotomy.

However, fine needle PAD is not always efficacious as the draining tube can become obstructed by necrotic tissue and blood coagulates.  Sump drainage (a type of surgical draining consisting of two tubes, one fine tube for normal saline irrigation and another larger tube for negative suction of body fluids and irrigation) can avoid the problems of obstruction but traditionally requires a laparotomy for placement. The authors have developed a method of placing the sump drain through a trocar, thereby avoiding the need for a laparotomy. A 12mm trocar is used to create a port for the laparoscope and to drain the intra-abdominal abscess.


THE PROCEDURE

When an abscess is identified on ultrasound or computerised tomography (CT) scan, the site and depth of the puncture required is decided [Fig 1].

Figure 1 – Intra-abdominal abscess is diagnosed by computerised tomography (CT) scan (centre of image).Figure 1 - Intra-abdominal abscess is diagnosed by computerised tomography (CT) scan (centre of image).

 

 

 

 

 

 

The patient is taken to the operating room and a second ultrasound is performed to identify the correct position for the puncture site, which is then marked [Figs 2 and 3].

Figure 2 – The site of the abscess is confirmed in the operating theatre.Figure 2 - The site of the abscess is confirmed in the operating theatre.

 

 

 

 

 

Figure 3 – The puncture site is marked on the patient’s abdomen.

Figure 3 - The puncture site is marked on the patient's abdomen.

 

 

 

 

 

 

Following disinfection and local anaesthesia [Fig 4], the site is confirmed through fine needle aspiration and abscess fluid is collected for culture

Figure 4 – Local anaesthesia is administered.

Figure 4 - Local anaesthesia is administered.

 

 

 

 

 

 

 

A 15mm incision is made at the puncture site in the skin and sub-skin tissue [Fig 5].

Figure 5 – A 15mm incision is made into the patient’s abdomen.Figure 5 - A 15mm incision is made into the patient's abdomen.

 

 

 

 

 

 

A 12mm trocar is placed into the abscess [Fig 6].

Figure 6 – A 12mm trocar is introduced into the intra-abdominal abscess cavity.Figure 6 - A 12mm trocar is introduced into the intra-abdominal abscess cavity.

 

 

 

 


 

A 10mm sump drain is then threaded through the trocar and into the cavity [Fig 7].

Figure 7 – The sump drainage is fed through the  12mm trocar.

Figure 7 - The sump drainage is fed through the 12mm trocar.

 

 

 

 

 

Page Points

  • Postoperative intra-abdominal abscess is often a cause of deep space surgical site infection (SSI)
  • Most intra-abdominal abscesses are treated using percutaneous abscess drainage (PAD)
  • PAD is not always efficacious as the tube can become blocked by necrotic tissue and blood coagulates
  • Sump drainage with saline irrigation can negate obstruction problems, but requires laparotomy
  • The authors have a developed a method of placing the sump drain through a trocar