Clinical application of ultrasound-guided percutaneous posterior approach for draining presacral abscesses

doi:10.3877/cma.j.issn.1672-6448.2018.04.012

Abstract

Abstract:

Objective

To assess the value of percutaneous posterior ultrasound-guided transgluteal approach for draining presacral abscesses.

Methods

From June 2013 to December 2015, retrospectively reviewed were performed in 48 patients with presacral abscesses confirmed by CT or magnetic resonance imaging (MRI) were retrospectively reviewed, and these patients underwent percutaneous US-guided transgluteal abscess drainage and catheter placement. The medical records were reviewed to determine the origins, location, and size of the abscesses, size of catheter, duration of catheter drainage, incidence of catheter-related pain and procedure-related complications, and short and long-term outcomes. The duration of drainage among different size of drainage catheter was compared, and the correlation between the volume of abcess and duration of abcess drainage was analyzed.

Results

The origins of the pelvic abscesses included anastomotic leakage after colorectal cancer surgery (n=38) and congenital macrocolon operation (n=3), radiation proctitis (n=2), recurrence of rectal cancer complicated with intestinal perforation, Crohn disease (n=1), appendicitis with abscess formation (n=1), rectal fistula (n=1), and postoperative pancreatic pseudocyst (n=1). The abscesses were 24-135 mm in diameter. The volume of the abscesses was 4.8-283.4 ml. The sizes of catheters used were 8-12F, and the mean duration of drainage was 13 days (range:1-52). In 42 (91.3%) of 46 patients, there was complete resolution of the abscess following transgluteal drainage, without subsequent surgery. In four of 46 (8.7%) patients, incomplete resolution necessitated subsequent surgery. No significant difference in drainage time was observed among 8-16F catheters (all P>0.05). The volume of abscess was positively correlated with the drainage time (r=0.281, P<0.05). No major complications were observed, either during or after the transgluteal procedure.

Conclusion

Percutaneous US-guided transgluteal drainage is a safe, effective and well tolerated alternative to surgery for deep pelvic abscesses, and thus is worthy of clinical application.

Key words: Ultrasonography, interventional, Abscesses, Drainage

Yao Chen, Si Qin, Wenjing Zhang, Junli Yu, Wenjie Cheng, Guangjian Liu. Clinical application of ultrasound-guided percutaneous posterior approach for draining presacral abscesses[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(04): 298-302.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2018.04.012

https://chaosheng.cma-cmc.com.cn/EN/Y2018/V15/I04/298

Figures/Tables 2

References 15

[1]	Walser E,Raza S,Hernandez A, et al. Sonographically guided transgluteal drainage of pelvic abscesses[J]. AJR Am J Roentgenol, 2003, 181(2): 498-500.
[2]	Peng T,Dong L,Zhu Z, et al. CT-guided Drainage of Deep Pelvic Abscesses via a Percutaneous Presacral Space Approach: A Clinical Report and Review of the Literature[J]. Acad Radiol, 2016, 23(12): 1553-1558.
[3]	Mcgahan JP,Wu C. Sonographically guided transvaginal or transrectal pelvic abscess drainage using the trocar method with a new drainage guide attachment[J]. AJR Am J Roentgenol, 2008, 191(5): 1540-1544.
[4]	Robert B,Chivot C,Rebibo L, et al. Percutaneous transgluteal drainage of pelvic abscesses in interventional radiology: A safe alternative to surgery[J]. J Visc Surg, 2016, 153(1): 3-7.
[5]	Harisinghani MG,Gervais DA,Maher MM, et al. Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases[J]. Radiology, 2003, 228(3): 701-705.
[6]	Cinat ME,Wilson SE,Din AM. Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess[J]. Arch Surg, 2002, 137(7): 845-849.
[7]	Men S,Akhan O,Koroglu M. Percutaneous drainage of abdominal abcess[J]. Eur J Radiol, 2002, 43(3): 204-218.
[8]	Harisinghani MG,Gervais DA,Hahn PF, et al. CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome[J]. Radiographics, 2002, 22(6): 1353-1367.
[9]	Butch RJ,Mueller PR,Ferrucci JJ, et al. Drainage of pelvic abscesses through the greater sciatic foramen[J]. Radiology, 1986, 158(2): 487-491.
[10]	Sudakoff GS,Lundeen SJ,Otterson MF. Transrectal and transvaginal sonographic intervention of infected pelvic fluid collections: a complete approach[J]. Ultrasound Q, 2005, 21(3): 175-185.
[11]	Ryan RS,Mcgrath FP,Haslam PJ, et al. Ultrasound-guided endocavitary drainage of pelvic abscesses: technique, results and complications[J]. Clin Radiol, 2003, 58(1): 75-79.
[12]	Varghese JC,O′Neill MJ,Gervais DA, et al. Transvaginal catheter drainage of tuboovarian abscess using the trocar method: technique and literature review[J]. AJR Am J Roentgenol, 2001, 177(1): 139-144.
[13]	Lambiase RE,Cronan JJ,Dorfman GS, et al. Postoperative abscesses with enteric communication: percutaneous treatment[J]. Radiology, 1989, 171(2): 497-500.
[14]	Cahill AM,Baskin KM,Kaye RD, et al. Transgluteal approach for draining pelvic fluid collections in pediatric patients[J]. Radiology, 2005, 234(3): 893-898.
[15]	Robert B,Chivot C,Fuks D, et al. Percutaneous, computed tomography-guided drainage of deep pelvic abscesses via a transgluteal approach: a report on 30 cases and a review of the literature[J]. Abdom Imaging, 2013, 38(2): 285-289.

Please choose a citation manager

Content to export