Large-bore aspiration of complex intra-abdominal abscesses using a mechanical aspiration device

To describe the use of a large-bore mechanical aspiration system (FlowTriever Aspiration Catheter) as an off-label intervention for the evacuation of complex intra-abdominal abscesses that were refractory to standard percutaneous drainage techniques. Two patients with large, complex intra-abdominal abscesses underwent aspiration using the FlowTriever Aspiration Catheter following failure of conventional catheter drainage. One patient had a walled-off necrotic collection from necrotizing pancreatitis; the other developed a postoperative abscess following appendectomy for perforated appendicitis. In each case, tract dilation was performed to accommodate the large-bore aspiration catheter, and follow-up CT imaging was used to assess treatment response. In both cases, the FlowTriever Aspiration Catheter enabled high-flow aspiration of solid and purulent material, with successful placement of large-bore drainage catheters. Follow-up imaging demonstrated marked reduction or near-complete collapse of the abscess cavities. No procedure-related complications were observed. Large-bore mechanical aspiration with the FlowTriever Aspiration Catheter may offer an effective adjunct or alternative to catheter upsizing and fibrinolytic therapy in patients with complex intra-abdominal abscesses, particularly when standard drainage techniques are unsuccessful. This approach may reduce the need for repeat interventions or surgical debridement in appropriately selected patients.