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Tricks - Colonic Perforation, Complication Of Percutaneous Drainage Of...
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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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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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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
On arrival to emergency room, the patient had an abdominal mass and CT showed a large collection at right iliac fossa
Percutaneous drainage was performed by interventional radiology with catheter placement
The next day after drainage, the patient exhibited bleeding through the catheter
Follow-up CT and abdominal X-ray with contrast through the catheter revealed the catheter was positioned in the cecum
After catheter removal, the team continued active observation and antibiotic treatment for 10 days
One week later, ultrasound showed the abscess had resolved
At 8 weeks follow-up, the patient was well and ultrasound was normal
Because the patient did not have appendicitis, interval appendectomy was not considered
Colonic injury from percutaneous drain may not be recognized because there is no obstructive pattern
A GlobalCast audience poll from a few months prior showed almost 60% would perform percutaneous drainage for a well-formed abscess instead of operating
The majority of faculty present would have placed a percutaneous drain in this patient with a well-formed abscess
Small bowel injuries from percutaneous drains have been observed by faculty
When a drain is found to be in the colon, backing the catheter out is an acceptable management approach
Faculty typically just remove the catheter when it is found to be in the colon