Table 1 Clinical characteristics and management of the six patients that developed iatrogenic pleural space infections after percutaneous drainage of intraabdominal/subphrenic infected collections
Patient | Age-gender | Primary pathology Primary intervention Indication for intraabdominal drainage | Time interval between percutaneous drainage and diagnosis of pleural space infection | Type of pleural space infection | Treatment of pleural space infection | Bacteria isolated in intraabdominal fluid collection and pleural effusion | Outcome |
|---|---|---|---|---|---|---|---|
#1 | 52-Female | Large retroperitoneal mass | 24 hours after intraabdominal drain exchange | Uncomplicated pleural effusion exsudative phase of empyema (stage I) | Needle aspiration | Abdomen: Candida glabrata and Staphyloccocus epidermidis | Symptoms resolved within 24 hours after pleural drainage. |
Multivisceral en bloc resection (right upper abdominal quadrant) | Pleura: sterile | CT scan 10 days later demonstrated complete resolution. | |||||
Subphrenic abscess | |||||||
#2 | 73-Female | Colon cancer metastatic to the liver | 24 hours after additional intraabdominal drain placement | Complicated pleural effusion with loculations (fibrinopurulent phase of empyema (stage II)) | Chest tube drainage | Abdomen: Enterococcus sp., Enterobacter cloacae and Lactobacillus sp. | Symptoms resolved. |
Radiofrequency ablation of a liver metastasis | Pleura: sterile | Chest tube was removed 3 days later and patient discharged on day 8 after pleural drainage. | |||||
Perihepatic abscess | Pleuritic pain resolved. | ||||||
#3 | 51-Female | Gallbladder cancer Central hepatectomy with portal lymphadenectomy Perihepatic abscess | 4 days after drain placement | Complicated pleural effusion (fibrinopurulent phase of empyema (stage II)) | Chest tube drainage | Abdomen & Pleura: Methicillin-sensitive Staphylococcus aureus (MSSA) | Chest tube removed at day three. Patient discharged at day five post pleural drainage with complete recovery. |
#4 | 77-Male | Colon cancer metastatic to the liver Partial hepatectomy Emphysematous cholecystitis (Video 1) | 17 days after drain placement (cholecystostomy tube) (Video 1) | Complicated pleural effusion (fibrinopurulent phase of empyema (stage II)) | Chest tube drainage & intrapleural fibrinolytic therapy | Abdomen: Enterococcus faecalis, Enterobacter aerogenes and Escherichia coli | Persistent biliary drainage 60 days after chest tube insertion that remained in place. |
Pleura (culture obtained 17 days after intraabdominal culture): Pseudomonas aeruginosa | Death related to primary pathology (75 days after liver surgery). | ||||||
#5 | 57-Female | Alcohol-induced cirrhosis | 10 days after additional (multiple) intraabdominal drain placements | Complicated pleural effusion (fibrinopurulent phase of empyema (stage II)) | Chest tube drainage & intrapleural fibrinolytic therapy | Abdomen: Enterococcus faecium | Symptoms resolved. Chest tube removed 4 |
Right lobe live donor liver transplantation. Subphrenic abscess | Pleura: Enterococcus faecium | days later. Complete recovery (last follow-up 1 year later). | |||||
#6 | 52-Male | Pancreatic tail cyst Distal splenopancreatectomy Peripancreatic abscess | 36 hours after upsizing of drain (Figure 1) | Complicated pleural effusion (fibrinopurulent phase of empyema (stage II)) | Chest tube drainage, VATS decortication | Abdomen & Pleura: Pseudomonas aeruginosa | Symptoms resolved. Patient discharged on day 8 after surgery. Complete recovery (last follow-up two years later). |