Video-Assisted Abscess Cavity Debridement after Failed Percutaneous Drainage: A Case Report

Abstract

            A viscous intra-abdominal abscess is challenging to drain by percutaneous drainage (PCD); however, open drainage might be prohibited, especially in a high surgical risk patient. An optional procedure was described in this case report. A 63-year-old Thai female presented with left side abdominal pain with sepsis and multi-organ failure. Computed tomography (CT) scan revealed a large intra-abdominal abscess, sized 33 cm in the largest diameter. PCD was performed by a 12-Fr pigtail catheter, which was later replaced with a 28-Fr tube drain due to drain obstruction from thick content. Unfortunately, her symptoms worsened. Re-evaluation with CT scan demonstrated persisting intra-abdominal abscess, measured 10.1x8.4x28.9 cm. After surgical and anesthetic risks were discussed, video-assisted drainage and debridement were performed with technical success. In addition, the abscess wall was biopsied for pathological examination. She recovered and was discharged uneventfully.