Catheter drainage was performed using the Seldinger technique as described in the literature6 as a joint effort between the surgeon and the radiologist. Injectable atropine 0.5 mg was given intramuscularly half an hour before the procedure. Abscess was localized by USG and a safe drainage route planned to avoid the bowels and costophrenic recess. Under all antiseptic precautions, the site was marked and infiltrated with 2% lignocaine. A 4 mm stab incision was made through which an 18 G guide wire introducer needle was passed under sonographic guidance till it reached the center of the cavity. A guide wire (Cordis 0.038, Johnson and Johnson) was then introduced through the needle and positioned inside the cavity following which the needle was removed keeping the guide wire in situ. Serial dilators (Devon Ltd.) were then passed over the wire to dilate the tract. The tract was dilated to an adequate size depending upon the viscidity of the pus. A pigtail catheter of size smaller than the last dilator was passed over the wire and positioned in the center of the abscess cavity under sonographic guidance. The guide wire was then withdrawn and the pigtail catheter was connected to a closed drainage bag and fixed to the skin. Sterile dressing was applied. The pus was sent for aerobic culture.
The daily output was monitored. The catheter was flushed daily with 10 ml of normal saline to prevent its blockage with debris.7 Metronidazole, ciprofloxacin and gentamicin were given in therapeutic doses for a period of 2-4 weeks. Alternate day USG studies were done to monitor the cavity size and volume and to confirm the position of tip of the catheter. Clinical improvement in the patients' condition was noted.
The pigtail catheter was removed when drainage become serous and it either ceased or was minimal (