Fibrinolytics in the Management of Complex Abdominal Collections: a case report and review of the literature

Complex intra-abdominal collections typically present management challenges, with percutaneous drainage remaining the standard of care. Fibrinolytic therapy has limited data for complex intra-abdominal collections despite solid evidence in intrapleural empyema. Here, we report a case of successful fibrinolytic therapy in a patient with persistent intra-abdominal collection. A 57-year-old woman with a history of open Roux-en-Y gastric bypass presented with a perforated marginal ulcer. Following successful surgical management, she developed a recurrent/persistent intra-abdominal collection that failed several percutaneous drainage attempts. Alteplase was administered through the abdominal drain, resulting in complete resolution of the collection. Despite limited evidence, fibrinolytic therapy for complex abdominal collections appears applicable and safe in selected cases. Further large series and randomized trials are needed to examine its efficacy and cost-effectiveness.