Percutaneous drainage of subphrenic fluid collections that occur after splenectomy: efficacy and safety of transpleural versus extrapleural approach

The purpose of this study was to compare the safety and efficacy of transpleural and extrapleural approaches for draining left subphrenic abscesses in patients who have had splenectomy.Twenty-five patients who had percutaneous catheter drainage (28 drainages) of postsplenectomy fluid collections were studied. Twenty drainages were transpleural and eight were extrapleural. In eight of the 20 transpleural drainages, it was elected to place the catheter transpleurally. In the remaining 12 patients, catheter drainage was judged to be transpleural on review, despite efforts to use an extrapleural approach.Sixteen of 18 patients who had transpleural percutaneous drainage and six of seven patients who had true extrapleural (subcostal) percutaneous drainage were cured by catheter drainage requiring no further intervention. The mean number of days of drainage was not significantly different (p.05) for the group drained transpleurally (mean, 18 days; range, 1-90 days) versus the group drained extrapleurally (mean, 20 days; range, 6-43 days). Complications (pneumothorax) requiring treatment were seen in two patients in whom a transpleural approach was used and in none of the patients in whom an extrapleural approach was used. Complications that did not require treatment were seen in four further patients drained transpleurally. These were inadvertent placement of catheter into pleural space (two patients) and pneumothorax not requiring treatment (two patients). No patient had an empyema.Transpleural drainage of left subphrenic collections occurring after splenectomy is associated with a slightly increased complication rate but has a success rate similar to that of extrapleural drainage.