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Colonic Perforation-Complication of Percutaneous Drainage of Appendiceal...
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Abdominal Pain 5 items
Chapter 1 of 2 · Case-Based Learning
Case presentation
Case presentation: appendiceal abscess with catheter complication
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What the experts said
The patient was an 8-year-old girl with 10 days of abdominal pain treated with antibiotics and analgesics without clear diagnosis
CT showed a large collection at right iliac fossa
Percutaneous drainage was performed by interventional radiology with catheter placement
The patient exhibited bleeding through the catheter the next day
Follow-up CT and abdominal X-ray with contrast through the catheter revealed the catheter was in the cecum
The catheter was removed and the patient was managed with active observation and antibiotic treatment for 10 days
Ultrasound one week later showed the abscess had resolved
At 8 weeks follow-up, the patient was well and ultrasound was normal
Interval appendectomy was not performed because the patient did not have appendicitis
A GlobalCast audience poll showed almost 60% would perform percutaneous drainage for a well-formed abscess
Faculty consensus was that the majority would place a percutaneous drain in this patient with a well-formed abscess
Small bowel injuries from percutaneous drains have been observed
Colonic injury from percutaneous drain may not be recognized because there is no obstructive pattern
When catheter perforation into bowel is recognized, backing the catheter out works fine