Abstract
IntroductionPercutaneous or endocavitory drainage of a diverticular abscess under radiological guidance often enables one to perform a one-staged resection and anastomosis (without stoma formation) instead of a two-staged procedure. It reduces the significant postoperative morbidity and mortality associated with the conventional emergency surgical management. However, radiological guidance is not always available due to limited resources during out-of-hours.Case presentationA 78-year-old Caucasian woman underwent transrectal drainage of a diverticular abscess performed with a pigtail catheter without radiological guidance. Technical details of the procedure are described and alternative options discussed.ConclusionIn carefully selected patients, per-rectal drainage using a pigtail catheter can be performed without radiological guidance and the procedure offers a simple and effective way of controlling sepsis.
Highlights
Percutaneous or endocavitory drainage of a diverticular abscess under radiological guidance often enables one to perform a one-staged resection and anastomosis instead of a twostaged procedure
In carefully selected patients, per-rectal drainage using a pigtail catheter can be performed without radiological guidance and the procedure offers a simple and effective way of controlling sepsis
Patients with diverticular abscess were historically managed by a three-staged procedure - drainage of abscess with diversion colostomy followed by resection of diseased segment of the bowel and, restoration of bowel continuity
Summary
Diverticular abscess is the most common complication of acute diverticulitis [1]. Patients with diverticular abscess were historically managed by a three-staged procedure - drainage of abscess with diversion colostomy followed by resection of diseased segment of the bowel and, restoration of bowel continuity. Resuscitation with intravenous fluids, antibiotics and adequate analgesia remains an integral part of the management This is followed by elective single-staged resection and anastomosis of the sigmoid colon once the acute inflammation in the colon and pericolic tissue subsides. Percutaneous drainage of an abscess is successful in allowing a later, more elective, single-stage resection and anastomosis in 74% of patients with diverticular abscess [6]. Those with smaller abscesses are often treated with intravenous antibiotic therapy alone [1]. We describe a case of complicated diverticular disease associated with a pelvic abscess successfully managed by transrectal drainage with a pigtail catheter without image guidance.
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