Ecografia interventionala in drenajul colectiilor abdominale

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ALEXANDRU ANDRITOIU

rolul ecografiei in ghidarea imagistica a drenajului colectiilor abdominale-exemplificari cu cazuistica personala

Health & Medicine

E
COGRAF INT RVE IONAL
IA
E
NT
A
IN COL CT E AB
E IIL
DOM
INAL
E

Andritoiu A, Mercut D, Silosi C, Resceanu Aurelia,
Spitalul Clinic de Urgenta Militar
,,Dr. Stefan Odobleja,, Craiova

Definitie

Manevre invazive efectuate sub ghidaj US, in
scop de DIAGNOSTIC si/sau TERAPEUTIC

US interventionala
• Punctie/biopsie

• Drenaje percutane

Drena percutan in
jul
colectiile abdom
inale

T
ehnica
•
•
•
•
•

Truse de drenaj
Abord pecutan ghidat US, CT
Scop diagnostic
Evacuator
Terapeutic

Indicatii
•
•
•
•
•

Abces subfrenic
Pseudochist pancreas
Abces hepatic
Chist hepatic simptomatic
Chist hidatic

Caz clinic
• CR, B, 41 ani
• Stenoza pilorica operata-complicata cu
fistula de bont - sepsis
• US – colectie neomogena interhepatodiafragmatic
• Drenajul percutana al colectiei (ghidaj US)
• Culturi : E Coli

Caz clinic
•
•
•
•
•
•

CM, B, 38 ani
Dureri abdominale difuze
Febra
Stare generala alterata (sepsis)
Abuz recent de alcool
US/CT abdomen: colectie transonica in
bisac pe ambele flancuri

P terapeutic
lan
ABORD CHIRURGICAL
• Lombotomie dr
• Drenaj
• Ineficient

•
•
•
•

ABORD ECHOINTERVENTIONAL
Eco-2D
Punctie aspirativa ac fin
21 G
Eficient !!!

P
eritonita biliara prin
perforatie colecistica

Caz clinic
• C I, M, 48 ani
• Clinic: durere intensa, socogena in
hipocondrul drept cu iradiere in umarul
drept
• APP: limfom gastric operat (gastrectomie
totala) in ultimile 6 luni

US

Colectie interhepato-diafragmatica

Colecist perforat, mulat pe calculi

Insertia trocarului sub ghidaj ecografic
Bila drenata in exces din cavitatea peritoneala

CONCLUZIE
Manevrele interventionale efectuate sub ghidaj
imagistic confera un plus de siguranta si eficienta
in diagnosticul si drenajul colectiilor abdominale

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