Radiologisch-interventionelle Drainage bei abdomineller Sepsis

Background: Abdominal abscesses are caused by putrid infections of the intestine and the abdominal cave as well as by pancreatic pseudocysts. They are foci of septic dissemination. Anatomic location and intraabdominal spread can be exactly determined by computed tomography (CT) imaging. Here, simple abscesses are clearly distinguishable. Complex abscesses remain multilocular. Radiological or surgical drainage is indicated in abscesses >50 mm. Method: Depending on the anatomic site, draining of the abscess can be performed from ventral, perineal, vaginal, or transgluteal. Different methods such as direct puncture, tandem-trocar and Seldinger technique are described. During puncture CT imaging is performed by fluoroscopy or successive CT images. Results: CT-guided percutaneous drainage (PAD) is the recommended first-line therapy of uncomplicated and easily accessible abdominal abscesses. The possible injury of vital structures, such as intestine, spleen, or large blood vessels, means a contraindication. Conclusion: PAD is a safe interventional technique. Its therapeutic success is comparable to surgical intervention, with less puncture-related morbidity and a shorter hospital stay.