Post nephrectomy collection and CT guided drainage

Case contributed by Ian Bickle


Fever and loin pain 2 months after right nephrectomy for non-malignancy indication

Patient Data

Age: 30 years
Gender: Male

Right nephrectomy.

Intra-abdominal collection in the right flank, which is extending through the abdominal wall musculature into the subcutaneous tissues.

Patient reluctant for further surgery. The collection was poorly delineated on ultrasound. CT guided drainage performed.

Step-by-step images of CT guided Seldinger drainage, using CT fluroscopy.

1. Surface markers to aid drainage in place.  See how much more difficult the collection is visualize without contrast in terms of performing the procedure.

2. After local anesthetic infiltration, the 2 part introducer needle is inserted and the position rechecked, before entering the retroperitoneum.

3. Introducer needle enters the collection, with the use of CT fluroscopy.  Pus is aspirated to confirm exact location.

4. Stiff guidewire placed into collection

5. Distance to edge of collection measured to be aware of distance to advance the metal trocar, before leaving the drain in situ.

6. 8F locking drain within the collection


Case Discussion

CT guided percutaneous drainage is a minimally invasive technique. It is less commonly performed than ultrasound guided drainage, but has advantages particularly in certain locations like the retroperitoneum and in patients of large body habitus.

Most modern CT machines have fluoroscopy functions making the procedure most dynamic for the operator.

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