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The purpose of this study was to identify the details of percutaneous catheter drainage (PCD) of pyogenic liver abscesses, the etiologic factors, and the management techniques that contribute to successful treatment.The records of 75 consecutively registered patients who underwent PCD of 96 abscesses at a single institution between May 2009 and May 2014 were retrospectively reviewed. Thirty-nine patients (52%) were oncology patients, and 36 (48%) had recently undergone abdominal surgery. Primary success was defined as abscess healing with the primary PCD intervention and 30-day postdrainage survival. Salvage success was defined as abscess healing with follow-up secondary PCD placement for symptomatic hepatic satellite collections or for clinical recurrence. Catheter adjustments were performed during follow-up to optimize existing drains. Univariate, multivariate, and general linear mixed model analyses were performed. The median follow-up time after catheter removal was 6 months (range, 2-62 months).Drains were primarily successful in 54 patients (72%), and 17 patients (23%) needed salvage PCD; thus, overall success was achieved in 71 patients (95%). The other four patients (5%) died of sepsis. The primary success rate was reduced in patients with unresectable malignancies (p = 0.01), multiple abscesses (p = 0.01), and output ≥ 15 mL/d at catheter endpoint (n = 7, p = 0.001). Only unresectable malignancies had slightly lower overall success. Large abscesses (150 cmPCD was effective first-line treatment of complicated pyogenic liver abscesses, which often require catheter adjustment and salvage drainage procedures to reliably achieve success.

The purpose of this study was to evaluate whether a valved peripherally inserted central catheter (PICC) design would result in a lower incidence of occlusion, infection, and malfunction than a clamped catheter.Three hundred sixty-two study patients (233 men, 129 women; mean age, 44 years) were randomized to receive a clamped (n = 182) or valved (n = 180) 5-French single-lumen PICC. Catheters were placed under fluoroscopic (n = 331) or sonographic guidance (n = 31). The valved PICC was flushed with saline solution, and the clamped PICC was flushed with a heparin-saline solution. All patients were prospectively followed up at least weekly for catheter status and complications.Percutaneous placement with the catheter tip in the central veins was successful in 99% of patients. Mean dwell time was 34 days. Twenty-six occlusive or infectious complications occurred in the clamped catheter group and 12 in the valved catheter group (p = .02). The clamped and valved catheter groups had 13 and five occlusions, respectively (p = .06), and 12 and five catheter-related blood stream infections, respectively (p = .09). Most occlusions (68%) were treated successfully with urokinase, and site infection or sepsis was treated by catheter removal.We found a statistically significant difference in the complication rate for the valved PICC compared with the clamped PICC. With the valved PICC, occlusion and infection were reduced, and patients having these catheters did not require heparin flushes.

A 79-year-old man presented with progressive dysphagia. He had a history of antireflux surgery 16 years earlier and had undergone a colectomy with left cecostomy and adjuvant radiation therapy for colon cancer 18 years earlier. Dual-chamber pacemakers were placed 7 years before for sick sinus syndrome. The patient presented with frequent regurgitation of undigested food, progressive dysphagia, and a 40-lb (18 kg) weight loss over 4 months. Barium swallow revealed a large midesophageal diverticulum. A right thoracotomy and repair were planned after hospital admission for hydration and nutritional support. The chest was entered above the sixth rib through a posterolateral thoracotomy. The right lung was deflated, and a right upper lobe adhesion to the chest wall was released. The azygos vein was transected to gain exposure to the diverticulum, which was associated with inflammation and adhesions in the posterior mediastinum. The diverticulum was resected and the esophagus repaired. Because of persistent chylous leakage from the chest tubes, the patient was returned to the operat