Drainage Of Pelvic Abscesses Research Articles

Sonographically guided transgluteal drainage of pelvic abscesses.

Sonographically guided transgluteal drainage of pelvic abscesses.

Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases.

To assess the effectiveness of a computed tomographic (CT) image-guided transgluteal approach for percutaneous drainage of deep pelvic abscesses as an alternative to surgical drainage. The medical records of 140 patients who underwent percutaneous CT-guided transgluteal drainage of 154 deep pelvic abscesses were reviewed to determine the origins, location, and size of the abscesses; volume of initial aspirate; organisms identified in fluid culture; duration of catheter drainage; incidence of catheter-related pain and procedure-related complications; and short- and long-term outcomes. The resultant data were analyzed with a Fisher exact test for difference in the incidence of postprocedural catheter-site pain between transpiriformis and infrapiriformis approaches. The origins of the pelvic abscesses included postoperative fluid collection (n = 115), perforating appendicitis (n = 6), diverticulitis (n = 16), tubo-ovarian inflammation (n = 5), Crohn disease (n = 10), and internal bowel fistula due to irradiation (n = 2). The abscesses were 4-12 cm in diameter. The volume of the aspirate was 5-310 mL. Laboratory cultures of the aspirate grew mixed flora, but the organism most frequently isolated was Escherichia coli. Catheters were removed after a mean of 8 days. In 134 (96%) of 140 patients, there was complete resolution of the abscess following transgluteal drainage, without subsequent surgery. In six of 140 (4%) patients, incomplete resolution necessitated subsequent surgery for postoperative fluid collection (n = 3), diverticulitis (n = 2), or perforating appendicitis (n = 1). Complications of transgluteal drainage were rare and included hemorrhage in three (2%) of the 140 patients. There was no procedure-related mortality. A transpiriformis approach was significantly more likely to be associated with postprocedural pain (P <.001) than was an infrapiriformis approach. Percutaneous CT-guided transgluteal drainage is a safe and effective alternative to surgery for deep pelvic abscesses. Major complications are rare.

Drainage of deep pelvic abscesses using therapeutic echo endoscopy.

The purpose of this study was to evaluate the clinical efficacy of endosonographically guided transrectal aspiration and drainage by plastic stent of deep pelvic abscesses, using a therapeutic echo endoscope device. Between September 2000 and June 2001, 12 patients (nine men, three women, mean age 67 years) were treated for a perirectal or a pelvic abscess using an endoscopic ultrasound (EUS) technique. The drainage of these fluid collections was performed under EUS guidance, using therapeutic EUS scopes with a large working channel. No major complication occurred during this study. Transrectal stent insertion succeeded in nine patients. In three patients, only aspiration was possible. Among the nine patients in whom a stent was successfully introduced into the fluid collection, complete drainage without relapse was achieved in eight patients (mean follow-up 10.6 months, range 6-14 months). The stent was removed endoscopically after 3 to 6 months. Drainage was incomplete in one patient (with a large abscess, diameter > 8 cm), who subsequently underwent surgical drainage. However, two out of the three patients in whom aspiration alone was performed developed a recurrence of the abscess and required surgical treatment. EUS-guided drainage of deep pelvic abscesses could offer an alternative treatment to surgery in the management of these postoperative complications.

Pelvic abscess drainage with ultrasound

Objective: The treatment of a pelvic abscess is usually antibiotics and surgery. In this paper, we present the results after transvaginal ultrasound (TVS)-guided drainage of pelvic abscesses and a follow-up of 4–14 years.

Ultrasound-guided Endocavitary Drainage of Pelvic Abscesses: Technique, Results and Complications

AIM: To evaluate the experience in our institution with ultrasound-guided transrectal and transvaginal (endocavitary) drainage of pelvic abscesses. MATERIALS AND METHODS: Eighteen patients (four male, 14 female; mean age 55 years, range 30–78 years) presenting with pelvic abscesses were referred to our institution for therapeutic drainage over a 4 year period. Patients received broad-spectrum antibiotics prior to drainage, which was performed by either the transvaginal or transrectal route under ultrasound guidance. Patients were given sedo-analgesia in the form of midazolam and fentanyl and local anaesthesia was also employed. Eight French catheters were inserted into the abscess cavities, and patients were subsequently monitored on a daily basis by a member of the interventional radiology team until such time as it was deemed appropriate to remove the catheter. RESULTS: Eighteen catheters were placed in 17 patients, and transvaginal aspiration alone was performed in one patient. Drainage was successful in 16 of 17 patients, but a transgluteal approach was ultimately required in the remaining patient to enable passage of a larger catheter into an infected haematoma. The mean duration of drainage was 5 days, mean time to defervesce 2 days. Spontaneous catheter dislodgement occurred in four patients associated with straining, but this did not have any adverse effect in three of the four patients. CONCLUSION: Endocavitary drainage is an effective method of treatment for pelvic abscesses. Spontaneous catheter dislodgement does not affect patient outcome.

Percutaneous Abdominal and Pelvic Abscess Drainage Techniques-Part I: Tools of the Trade

This review is a pictorial essay discussing the tools used in the image-guided percutaneous drainage of abdominal and pelvic abscesses. Topics covered include drainage catheters, access devices, directional catheters, dilators and sheaths, localizing devices, and fixation devices and drainage systems.

Percutaneous Abdominal and Pelvic Abscess Drainage Techniques. Part II: Imaging Guidance, Catheter Insertion Techniques, and Access to Difficult Locations

Percutaneous Abdominal and Pelvic Abscess Drainage Techniques. Part II: Imaging Guidance, Catheter Insertion Techniques, and Access to Difficult Locations

CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome.

Deep pelvic abscesses may present a unique challenge for percutaneous drainage because of numerous overlying structures, which preclude safe percutaneous access. These structures include the pelvic bones, intestine, bladder, iliac vessels, and gynecologic organs. Use of the transgluteal approach to drain these abscesses can circumvent these obstacles and provide a useful surgical alternative or a temporizing measure. The transgluteal approach requires a thorough understanding of the anatomy of the sciatic foramen region and associated anatomic structures. The ideal approach for transgluteal access is to insert the catheter as close to the sacrum as possible, at the level of the sacrospinous ligament. Transgluteal drainage can be performed with the tandem-trocar technique or the Seldinger technique. Modifications of the procedure are needle aspiration not followed by catheter placement, use of the angled gantry technique, bilateral transgluteal drainage, combined anterior and posterior drainage, and drainage of necrotic pelvic masses. The transgluteal approach is a useful option in pediatric patients. Daily catheter care is essential for successful percutaneous catheter therapy. Although pain has been cited as a common complication of the technique, this complication can be minimized with judicious use of analgesia and a meticulous technique. Other complications are hemorrhage and catheter malposition.

Percutaneous Abdominal and Pelvic Abscess Drainage in Children - A Practical Approach

Percutaneous Abdominal and Pelvic Abscess Drainage in Children - A Practical Approach

The management of leaking rectal anastomoses by minimally invasive techniques.

The salvage of a leaking rectal anastomosis has been reported in selected cases. Herein we present our experience in the management of rectal anastomotic dehiscence by minimally invasive techniques. A total of 94 patients underwent anterior rectal resection for rectal cancer in an 18-month period. The operation was laparoscopic-assisted in 76 cases (81%). Clinical anastomotic dehiscences occurred in 10 cases (10.6%). Conservative therapy, including the percutaneous drainage of pelvic abscesses, was successful in three cases. Among the seven patients who required reoperation, the anastomosis was taken down in only one case. In four of these cases, the reoperation was performed laparoscopically, including peritoneal lavage and the creation of a diverting stoma. There were no complications resulting from the use of laparoscopy in the early postoperative period. Closure of the stoma was possible in eight patients. The salvage of a leaking rectal anastomosis is feasible in the vast majority of these cases (80%). The combination of laparoscopy and interventional radiology is a good alternative to laparotomy in patients who have had previous laparoscopic rectal excision.

Transrectal catheter drainage of deep abdominal and pelvic abscesses using combined ultrasonography and fluoroscopy.

To describe our experience with transrectal drainage of deep abdominal or pelvic abscesses guided by ultrasonography and fluoroscopy. Open study. Teaching hospital, Sweden. Eight seriously ill patients with deep abdominal or pelvic abscesses. Ultrasonographic and fluoroscopic transrectal drainage. Clinical follow-up. Eight patients (2 septic, 2 with high fever, and 2 with moderate fever) were effectively and safely drained without general anaesthesia. Their condition improved considerably within hours after drainage. Three patients had recurrent abscesses as a result of the underlying disease. The drainage overcame the sepsis in two patients and allowed a later elective operation. Transrectal ultrasonographic and fluoroscopic drainage is an effective and safe method for treatment of deep abdominal or pelvic abscesses in seriously ill patients.

PERCUTANEOUS NEPHROLITHOTOMY OF A PELVIC KIDNEY: A POSTERIOR APPROACH THROUGH THE GREATER SCIATIC FORAMEN

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 Jul 2001PERCUTANEOUS NEPHROLITHOTOMY OF A PELVIC KIDNEY: A POSTERIOR APPROACH THROUGH THE GREATER SCIATIC FORAMEN JAMES D. WATTERSON, ANTHONY COOK, RIKI SAHAJPAL, JOHN BENNETT, and JOHN D. DENSTEDT JAMES D. WATTERSONJAMES D. WATTERSON More articles by this author , ANTHONY COOKANTHONY COOK More articles by this author , RIKI SAHAJPALRIKI SAHAJPAL More articles by this author , JOHN BENNETTJOHN BENNETT More articles by this author , and JOHN D. DENSTEDTJOHN D. DENSTEDT Financial interest and/or other relationship with Boston Scientific, Cook Canada and Phillips Petroleum. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66114-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "PERCUTANEOUS NEPHROLITHOTOMY OF A PELVIC KIDNEY: A POSTERIOR APPROACH THROUGH THE GREATER SCIATIC FORAMEN." The Journal of Urology, 166(1), pp. 209–210 References 1 : Laparoscopic surgery for urolithiasis: pyelolithotomy, calyceal diverticulectomy and treatment of stones in a pelvic kidney. J Endourol2000; 14: 829. Google Scholar 2 : Laparoscopic pyelolithotomy in a pelvic kidney: a case report and review of the literature. J Soc Laparoendosc Surg1997; 1: 163. Google Scholar 3 : Drainage of pelvic abscesses through the greater sciatic foramen. Radiology1986; 158: 487. Google Scholar From the Departments of Urology and Radiology, University of Western Ontario, London, Ontario, Canada© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 166Issue 1July 2001Page: 209-210 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordsnephrostomy, percutaneousurinary calculikidneyMetricsAuthor Information JAMES D. WATTERSON More articles by this author ANTHONY COOK More articles by this author RIKI SAHAJPAL More articles by this author JOHN BENNETT More articles by this author JOHN D. DENSTEDT Financial interest and/or other relationship with Boston Scientific, Cook Canada and Phillips Petroleum. More articles by this author Expand All Advertisement PDF downloadLoading ...

Transvaginal interventional procedures: aspiration, biopsy, and catheter drainage.

Transvaginal ultrasonographically (US) guided procedures are simple and safe and often represent the only means of access to pelvic disease. Aspiration of cystic pelvic masses and core biopsy of solid pelvic masses can be easily performed by using the transvaginal route, an endoluminal US transducer, and a needle guide. Because of concerns about false-negative diagnosis and potential tumor seeding with biopsy of primary ovarian cystic lesions, the indications for transvaginal aspiration and biopsy of ovarian and adnexal lesions are predominantly therapeutic. Similarly, using an endoluminal probe with modification of the guide, one can also perform safe and effective trocar catheter drainage of pelvic abscesses via the transvaginal route. The transvaginal route is ideally suited to pelvic abscess drainage because of the proximity of the vaginal fornices to most pelvic fluid collections. The transvaginal route has the disadvantage of being semisterile; because of the risk of superinfecting previously noninfected pelvic pathologic conditions, the transvaginal approach should be used only for solid lesions or cystic lesions that can be completely aspirated. Familiarity with the transvaginal route of access is crucial for adequate treatment of many gynecologic and nongynecologic pelvic pathologic conditions.

New use of Argyle trocar catheter: treatment of pelvic abscess following transvaginal ultrasound-directed follicle aspiration (UDFA).

This report describes the use of an Argyle trocar catheter for the drainage of pelvic abscesses following transvaginal ultrasound-directed follicle aspiration (UDFA) for oocyte collection. Three patients treated with this technique recovered uneventfully. We conclude that the use of an Argyle trocar catheter for colpotomy in the management of pelvic abscesses appears to be simple and effective.

CT-Guided transgluteal drainage of deep pelvic abscesses in children: selective use as an alternative to transrectal drainage.

The transgluteal approach to abscess drainage through the greater sciatic foramen has been described in adults, but this route has not been as extensively studied in children. We performed CT-guided transgluteal percutaneous abscess drainage in seven children and assessed the results of drainage and catheter tolerance. Transgluteal catheters are well tolerated by children, and the transgluteal route is an effective approach to selected pelvic abscesses in children.

Transrectal ultrasonographically guided drainage of gynecologic pelvic abscesses

Objective: This study assessed the feasibility of ultrasonographically guided transrectal aspiration of gynecologic pelvic abscesses to treat patients for whom intravenous antibiotic therapies failed and whose abscesses were not optimally amenable to colpotomy drainage or transabdominal or transvaginal ultrasonographically guided aspiration. Study Design: This was a retrospective review of the first 15 women with pelvic abscesses that resulted from salpingitis or complications of gynecologic surgery who underwent transrectal pelvic abscess drainage after failure of antibiotic therapy. Results: Purulent material was aspirated from the abscesses in 14 of the 15 women. All 14 women with aspirated material were successfully treated with real-time ultrasonographically guided transrectal drainage; only 4 of the 14 had indwelling catheter placement. Conclusion: Ultrasonographically guided transrectal drainage of gynecologic pelvic abscesses is a safe and effective treatment of pelvic abscesses for women who do not have an adequate response to antibiotic therapy. (Am J Obstet Gynecol 2000;182:1382-8.)

CT-Guided Percutaneous Drainage of Tuberculous and Non-Tuberculous Deep Pelvic Abscesses

Objective: To assess the utility of comput- ed tomography (CT)-guided percutaneous drainage in the management of tuberculous and non-tuberculous deep pelvic abscesses. Material and Methods: Twelve patients with deep pelvic abscesses were drained under CT guidance. Nine patients were drained with an indwelling catheter of size ranging from 8 to 14 F. Needle aspiration and lavage were performed in 3 patients. Results: Successful drainage was accomplished in all the patients. A single-session catheter drainage was sufficient in all the cases. In 4 out of 12 patients the abscess was of tuberculous aetiology and all were effectively managed with indwelling catheter drainage. Conclusion: CT-guided percutaneous drainage of pelvic abscesses with appropriate chemotherapy is an easy, safe and effective alternative to surgery in the treatment of tuberculous and nontuberculous pelvic abscesses.

The Pippi Salle procedure for neurogenic urinary incontinence in childhood: a three-year experience.

A three-year retrospective study was performed to assess the place of the Pippi Salle bladder neck repair in the treatment of neurogenic bladder incontinence in both sexes in childhood. All children who underwent the procedure between November 1995 and November 1998 were studied retrospectively. There were 18 children: 12 with spina bifida, 5 with sacral agenesis and 1 with an idiopathic neurogenic bladder. There were 11 boys and 7 girls. Their age was 3-14 years (median 7 years) and the length of follow-up was 7 months to 3 years (median 2 years). A midline bladder wall flap was fashioned in all patients. The procedure was performed alone (n = 5) or in combination with a sigmoid colocystoplasty (n = 9) or a Mitrofanoff catheterisable stoma (n = 2) or both (n = 2). Diurnal continence (3 hours or more) was achieved in 11 of the 18 children (61%); 2 are dry for 2-2.5 hours and 5 are incontinent. Eight of the 18 children (44%) are completely dry during the night, 2 are damp and 8 are incontinent. Twelve children (67%) needed oxybutynin to maintain a good result. Complications arose in 5 children (28%): difficulty with catheterisation (n = 4) and pelvic abscess (n = 1). Seven children (39%) subsequently required further operations: exploration of bladder for urine leak (n = 2), reinsertion of dislodged catheter (n = 1), drainage of pelvic abscess (n = 1), bladder neck injection with macroplastique (n = 1) and bladder neck closure (n = 2). The Pippi Salle bladder neck repair has an undoubted place in the management of neurogenic urinary incontinence in childhood. However, in our experience, it has a relatively high complication rate and failure rate.

Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon.

Traditionally, left-sided colon obstruction is managed by a multistaged defunctioning colostomy and resection. However, there is growing acceptance of one-stage primary resection and anastomosis with on-table antegrade irrigation. This paper presents a series of patients managed prospectively by primary anastomosis without intraoperative colonic lavage. Emergency resection of acutely obstructed left-sided colonic carcinomas was performed. This was followed by primary anastomosis without on-table lavage after bowel decompression using a new technique. Fifty-eight consecutive, unselected patients underwent bowel decompression, resection and primary colocolic anastomosis. Only one patient developed a leak at the anastomotic site, requiring pelvic abscess drainage and transverse loop colostomy. One death occurred 12 h following surgery. Autopsy confirmed that this was due to myocardial infarction. Mean hospital stay was 9.8 days. Emergency surgery on the obstructed left colon can be carried out safely after decompression alone, without intraoperative colonic lavage.

Endosonography control of percutaneous paracoccygeal drainage of deep pelvic abscesses after rectum resection

Pelvic abscesses are severe complications after rectal surgery. In recent years, surgical drainage has been edged out by percutaneous drainage techniques. We report our experience with the drainage of postoperative pelvic abscesses via the paracoccygeal route controlled by endosonography. In eight patients the diagnosis of a retrorectal pelvic abscess was established by endosonography and confirmed by endosonographically controlled exploratory puncture. Drainage of the abscesses was performed via the paracoccygeal access route by trocar or Seldinger technique under permanent visual control by endoluminal sonography. Irrigation of the abscess cavity was than performed daily. In all cases drainage was successful without complications. Duration of drainage was 9-14 days with a mean of 10.8 days. In one patient there was a recurrence of the abscess because of early removal of the drainage catheter. Because of its overall availability and its good results, paracoccygeal percutaneous endosonographically controlled drainage seems to be a suitable uncomplicated method for drainage of postoperative pelvic abscesses.