Date of Award

January 2024

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Joshua Cornman-Homonoff

Abstract

ABSTRACTTitle: Percutaneous Management of Pelvic Fluid Collections: A 10-Year Series Authors: Chidumebi Alim, BSc1; Chinenye Okafor, MBBS, MPH2; Joshua Cornman-Homonoff, MD3

1Yale School of Medicine, New Haven, CT2Department of Neurology, Yale School of Medicine, New Haven, CT 3Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT

Percutaneous image-guided drainage has emerged as the preferred treatment for infected and symptomatic fluid collections of adequate size, particularly those in the pelvis. Despite this, the optimal approach to catheter placement and management remains unknown. The purpose of this study was to retrospectively evaluate a large cohort of patients to better characterize the factors affecting outcomes of pelvic fluid collection drainage as defined by number of abscessograms, total catheter dwell time, and complication rate.

187 patients who underwent 246 percutaneous image-guided catheter placements for drainage between Jan 2012 to Dec 2021 were included. Demographic, preprocedural, intraprocedural, and postprocedural variables were collected via chart review and analyzed to determine the presence of association with number of abscessograms, total catheter dwell time, and complication rate. All patients were followed until the catheter was removed or lost to follow up.

Patients averaged 60 years of age and were slightly more likely to be male. The clinical success rate was 88.2% (n=217), with collection recurrence in 9.3% (n=23) and surgery required post drainage in 2.8% (n=6). Two adverse events yielded an adverse event rate of 0.8%. A single abscessogram followed by catheter removal was performed in 80 (32.5%) cases, with 93 cases (37.8%) involving multiple abscessograms. Cases with purulent-appearing fluid were significantly more likely to develop a fistula (p=.04), and only the presence of fistula at first abscessogram was significantly associated with total number of abscessograms (p=.02).

In conclusion, image-guided pelvic abscess drainage has high clinical success and low complication rates.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 04/30/2025

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