Post on 03-Jun-2015
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ECOGRAFIA ECOGRAFIA INTERVENTIONALAINTERVENTIONALA
IN COLECTIILE ABDOMINALEIN COLECTIILE ABDOMINALE
Andritoiu A, Mercut D, Silosi C, Resceanu Aurelia, Spitalul Clinic de Urgenta MilitarSpitalul Clinic de Urgenta Militar ,,Dr. Stefan Odobleja,, Craiova
DefinitieDefinitie
Manevre invazive efectuate sub ghidaj US, in scop de DIAGNOSTIC si/sau TERAPEUTIC
US interventionalaUS interventionala
• Punctie/biopsie • Drenaje percutane
Drenajul percutan Drenajul percutan in colectiile in colectiile abdominaleabdominale
TehnicaTehnica
• Truse de drenaj
• Abord pecutan ghidat US, CT
• Scop diagnostic
• Evacuator
• Terapeutic
IndicatiiIndicatii
• Abces subfrenic
• Pseudochist pancreas
• Abces hepatic
• Chist hepatic simptomatic
• Chist hidatic
Caz clinicCaz clinic
• CR, B, 41 ani
• Stenoza pilorica operata-complicata cu fistula de bont - sepsis
• US – colectie neomogena interhepato-diafragmatic
• Drenajul percutana al colectiei (ghidaj US)
• Culturi : E Coli
Colectie Colectie abdominala abdominala
post-pancreatitapost-pancreatita
Caz clinicCaz 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
Plan terapeuticPlan terapeutic
ABORD CHIRURGICAL• Lombotomie dr• Drenaj• Ineficient
ABORD ECHO-INTERVENTIONAL
• Eco-2D• Punctie aspirativa ac fin• 21 G• Eficient !!!
Pseudochist pancreas - drenajPseudochist pancreas - drenaj
Peritonita biliara Peritonita biliara prin perforatie prin perforatie
colecisticacolecistica
• 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
Caz clinicCaz clinic
Colectie interhepato-diafragmatica Colecist perforat, mulat pe calculi
US
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