Percutaneous biopsies and drainages of abdominal fluid collections are standard procedures that are mainly performed under ultrasound (US) and computed tomography (CT) guidance.
Organ biopsy is usually performed for lesions of the pancreas, liver and kidney, as well as retroperitoneal masses. Less common indications are lesions of the spleen, which are prone to bleeding complications.
Both fine needle aspiration as for cytology, as well as miniaturized cutting needles for histology, not exceeding 18-20G, can be used for abdominal biopsies. However, automated biopsy guns are preferred because they offer an excellent sampling quality and the possibility to perform repeated biopsies with a single access. Fine needle aspiration is recommended in order to avoid major bleeding complications if an object for biopsy is located close to central and vascular structures. Fine needle aspiration biopsy (Fig. 1) allows bowel structures to be transversed in order to reach the lesion of interest, whereas this must be avoided when performing cutting needle biopsy. A frontal approach to lesions deep in the abdomen is usually performed using fine needle aspiration.
Obviously, access for drainage needs to avoid making both a pathway through the pleural space, as well as traversing through bowel structures.
Depending on their location, abscesses (Fig. 2) within organs or in the peritoneal or retroperitoneal cavity are approached by a trocar technique for a well exposed location, while a difficult approach requires an over-the-wire placement of drainage catheters. It is important to place sufficiently large bore drainage catheters (12-16F) to evacuate highly viscous fluid collections. The drain should be left in place until the abscess cavity has collapsed completely and less than 20 cc of fluid is collected per day.
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