A Novel Approach to the Management of an Intra-abdominal Abscess: A Case Report and Literature Review.

Abstract

Exploratory laparotomies for blunt or penetrating trauma often result in significant morbidity. Despite advancements in resuscitation, surgical techniques, and antibiotics, intra-abdominal abscesses remain a serious complication, contributing to poor outcomes and extended hospital stays. Percutaneous computed tomography-guided drainage is the standard treatment for abscesses, offering high success rates and low morbidity. However, its efficacy depends on factors such as abscess location and radiologist expertise. In cases where drainage is inaccessible, open or laparoscopic surgery may be required, which carries substantial risks. In rare situations, administering tissue plasminogen activator (tPA) via an abdominal drain has been shown to resolve abscesses effectively. This report discusses a 37-year-old male patient with a gunshot wound to the left upper abdomen, resulting in hemoperitoneum, gastric injury, and lacerations to the kidney and pancreas. Following surgical repair and placement of a Jackson-Pratt drain, the patient developed sepsis and a subphrenic abscess that could not be accessed for interventional radiology drainage. After weighing the risks and benefits, tPA was administered via the Jackson-Pratt drain, leading to clinical improvement. This innovative approach may offer an alternative for managing difficult-to-drain intra-abdominal collections, potentially reducing surgical intervention and associated morbidity. Currently, no large-scale studies or consensus exist regarding tPA use and dosing for abdominal collections, highlighting the need for further research. Insights from intrapleural tPA application could inform its broader use in intra-abdominal treatments.