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Complex Abdominal and Pelvic Abscesses: Efficacy of Adjunctive Tissue-Type Plasminogen Activator for Drainage¹

¹ From the Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114. From the 2006 RSNA Annual Meeting. Received May 1, 2007; revision requested June 28; revision received August 13; final version accepted October 31. Address correspondence to M.D.B. (e-mail: mdbeland{at}gmail.com).

Purpose: To retrospectively evaluate the effectiveness and safety of tissue-type plasminogen activator (tPA) for drainage of abdominal and pelvic abscesses refractory to simple catheter drainage.

Materials and Methods: This HIPAA-compliant study was approved by the Institutional Review Board; informed consent was waived. Forty-three patients (17 men, 26 women; mean age, 46 years; age range, 10–89 years) with a total of 46 abscesses underwent percutaneous drainage with 8.5–14-F catheters. Etiology was postoperative in 28 abscesses (60.9%) and varied in 18 (39.1%). Intracavitary tPA was initiated on the basis of viscous contents yielding minimal drainage at initial placement or if follow-up imaging showed a large residual collection despite satisfactory catheter position. A treatment cycle was 4–6 mg of tPA in 0.9% saline administered twice daily for 3 days. Drainage success was defined as evacuation of the abscess without surgery. Safety was evaluated on the basis of complications. Statistical analysis was performed by using the Student t test and Fisher exact test.

Results: Forty-six abscesses were initially drained by 51 catheters. Complete evacuation was achieved in 41 (89.1%) abscesses, whereas five (10.9%) required surgical drainage. Three (60%) of these five had a documented fistula, a higher (P = .02) percentage than in successfully drained abscesses. Three (6.5%) of the 46 abscesses recurred (12–95 days after catheter removal). There were no tPA-linked bleeding complications despite four patients receiving full systemic anticoagulation and 24 receiving prophylactic anticoagulation.

Conclusion: Intracavitary tPA is safe and effective for draining complex fluid collections, with most patients avoiding surgery.

© RSNA, 2008