PMC128809_01
CT of abdomen: Right kidney is enlarged and pushed forwards by the perinephric collection. In contrast to the right kidney, the left kidney is in the normal location and has normal size. Percutaneous catheter, which drains the right pertinephric collection, is seen emerging anteriorly by the side of right kidney.
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F1
The position of the catheter as it emerged anteriorly from the right perinephric space is shown in Figures 1 and 2.
CT of abdomen: The right kidney is enlarged. There is perinephric collection behind the right kidney. The right kidney is pushed forwards by the perinephric collection. The catheter, which was inserted for drainage of perinephric collection, is seen emerging from the abdominal cavity into the anterior abdominal wall.
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F2
The position of the catheter as it emerged anteriorly from the right perinephric space is shown in Figures 1 and 2.
CT of abdomen: The cephalic end of the baclofen pump is seen in the anterior abdominal wall. To the right of the baclofen pump, is seen the pigtail catheter emerging from the anterior abdominal wall. Behind the right kidney is the residual perinephric collection, which appears to have septa. In the posterior abdominal wall just behind the right kidney, is seen the tube which connects the baclofen pump located in the anterior abdominal wall to the intrathecal catheter.
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F3
The proximity of the drainage catheter as it exits the anterior abdominal wall, to the cephalic end of baclofen pump, is shown in the CT scan of abdomen. (Figure 3).
Clinical photograph of the abdomen (close-up view): The surgical scar of implantation of baclofen pump is seen. The pigtail catheter emerges close to the scar. The skin around the pigtail catheter is red and angry-looking. Approximate position of baclofen pump is marked on the skin with a pen.
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F4
Clinical photograph of front of abdomen of this tetraplegic patient shows the precise anatomical location of the catheter, as the catheter comes out of the anterior abdominal wall. (Figure 4). When figure 6 is compared with figure 4, the differences between the anterior and posterior surgical approaches become very obvious. The skin around the pigtail catheter became slightly inflamed and red. (Figures 4).
Scanogram of CT of abdomen shows baclofen pump, which has been placed in the anterior abdominal wall on right side. The tube, which delivers baclofen from the pump into the subarachnoid space, courses around the abdominal wall from the front to the back. A pigtail catheter is seen in the right perinephric space.
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F5
A two dimensional relationship of the pigtail catheter draining the perinephric haematoma to the baclofen pump may be appreciated in the scanogram taken during CT of abdomen (Figure 5).
Clinical photograph of another patient with cervical spinal cord injury and tetraplegia: This patient underwent ileal conduit urinary diversion since he had a urinary fistula from the prostatic urethra. Unfortunately, he developed stricture of distal ureters and required percutaneous nephrostomy drainage on both sides. The nephrostomy catheter emerges from the back. The location of the percutaneous nephrostomy catheter represents the traditional approach for draining a kidney or perinephric space, by inserting a catheter from the loin posteriorly. Compare the position of nephrostomy catheter of this patient with figure 4.
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F6
The classical way of placing a pigtail catheter from behind for drainage of a kidney is illustrated in figure 6. When figure 6 is compared with figure 4, the differences between the anterior and posterior surgical approaches become very obvious.