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