Presentation
Persistent fever following total gastrectomy for a gastrointestinal stromal tumor (GIST).
Patient Data
Two well-defined collections are noted. One is seen below the left diaphragmatic copula and extends to the retroperitoneum just above the left kidney. The other collection is related to the pancreatic body and tail.
Note: The patient wasn't given IV contrast as he had a history of hypersensitivity to iodinated contrast media and was critically ill.
CT-guided tube drainage was performed. The patient was positioned prone. The insertion site was marked on the skin by a metallic coin. A needle syringe was placed at the insertion site, and an aspirate was obtained. A (12F) pigtail tube drain was introduced into the collection. A post-procedural study was done to confirm adequate placement.
Tools used: 12F pigtail universal tube drainage catheter insertion set, collection bag, 20G spinal needle (yellow color), 20cc needle syringe, and a metallic coin.
Follow-up CT revealed a remarkable reduction in the size of both collections.
Annotated images showing the reduction in the size of both collections comparing pre-procedural films (green arrowheads) and post-procedural films (yellow arrowheads).
Aspirate examination results:
Gross appearance: 20 cc of pale yellow fluid, smears, and a cell block were prepared.
Microscopic examination: Sections prepared from the cell block revealed dense neutrophilic infiltrate, pus cells admixed with histocytes, and mesothelial cells.
Diagnosis: Suppurative smears.
Case Discussion
This is a case of a successful CT-guided drainage procedure for a patient who underwent total gastrectomy and splenectomy for a gastrointestinal stromal tumor (GIST).
The patient developed two intra-abdominal collections following the operation. Improvement was reflected by the reduction of the collection size and the decreased leukocytic count. Percutaneous image-guided drainage should be considered the first line of treatment for postoperative collections, as surgery is often tough in the early postoperative period.
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