Transrectal Drainage Research Articles

S2134 Safety and Efficacy of EUS-Guided Trans-Rectal Drainage of Deep Pelvic Abscesses in Children

S2134 Safety and Efficacy of EUS-Guided Trans-Rectal Drainage of Deep Pelvic Abscesses in Children

Transrectal Drainage Tube Use for Preventing Postendoscopic Submucosal Dissection Coagulation Syndrome in Patients With Colorectal Lesions: A Multicenter Randomized Controlled Clinical Trial.

Postendoscopic submucosal dissection (ESD) coagulation syndrome (PECS) prevention is one of the common postoperative complications of colorectal ESD. Considering the increasing incidence of PECS, it is critical to investigate various prevention methods. The objective of this study was to evaluate the efficacy of transrectal drainage tubes (TDTs) in PECS prevention in patients following colorectal ESD. From July 2022 to July 2023, a multicenter, randomized controlled clinical trial was conducted in 3 hospitals in China. Patients with superficial colorectal lesions ≥20 mm who had undergone ESD for a single lesion were enrolled. Initially, 229 patients were included in the study and 5 were excluded. Two hundred twenty-four were randomly assigned to the TDT and non-TDT group in the end. This open-label study utilized a parallel design with a 1:1 allocation ratio, and endoscopists and patients were not blind to the randomization, and a 24 Fr drainage tube was inserted approximately 10-15 cm above the anus after the ESD under the endoscopy and tightly attached to a drainage bag. The TDTs were removed in 1-3 days following the ESD. A total of 229 eligible patients were enrolled in this study, and 5 patients were excluded. Ultimately, 224 patients were assigned to the TDT group (n = 112) and non-TDT group (n = 112). The median age for the patients was 63.45 years (IQR 57-71; 59 men [52.68%]) in the TDT group and 60.95 years (IQR 54-68; 60 men [53.57%]) in the non-TDT group. Intention-to-treat analysis showed patients in the TDT group had a lower incidence of PECS than patients in the non-TDT group (7 [6.25%] vs 20 [17.86%]; relative risk, 0.350; 95% confidence interval [CI], 0.154-0.795; P = 0.008). In the subgroup analysis, TDTs were found to prevent PECS in patients of the female gender (odd ratio, 0.097; 95% CI, 0.021-0.449; P = 0.001), tumor size <4 cm (odd ratio, 0.203; 95% CI, 0.056-0.728; P = 0.011), tumor located in the left-sided colorectum (odd ratio, 0. 339 95% CI, 0.120-0.957; P = 0.035), and shorter procedure time (<45 minutes) (odd ratio, 0.316; 95% CI, 0.113-0.879; P = 0.023). The tube fell off in 1 case (0.89%) accidentally ahead of time. No TDT-related complication was observed. The results from this randomized clinical study indicate that the application of TDTs effectively reduced the incidence of PECS in patients after colorectal ESD ( chictr.org.cn Identifier: ChiCTR2200062164).

Image-Guided Transrectal Drainage of Pelvic Abscesses in Children.

To describe our technique and share our experience with image-guided transrectal drainage (TRD) of pelvic abscesses in children. Retrospective review and analysis of indications for image-guided TRD and examination of procedural outcomes in pediatric patients with pelvic abscesses over 8 years. A total of 69 patients (33 males and 36 females) with symptomatic pelvic abscesses underwent image-guided TRD. The median age and weight of the patients were 11.5 years (range, 3-18) and 46.8 kg (range, 15.1-118.0), respectively. The etiologies of the pelvic abscesses were perforated appendicitis (72.5%) and post-operative collections (27.5%). All patients presented with abdominal pain. Fever, emesis, and diarrhea were also common symptoms. The size of the pelvic abscesses ranged from 24.0 to 937.1 mL (median, 132.7). Technical success was achieved in 68 of 69 TRD procedures (98.6%). Clinical improvement was observed in all patients with technically successful TRD. The TRD catheter dwell time ranged from 0 to 10 days (median, 4.0). Most patients who underwent TRD for perforated appendicitis subsequently underwent elective appendectomy after the resolution of the pelvic abscess (84.0%). The median time from TRD to elective appendectomy was 2.8 months (range, 0.3-6.1). There were no procedure-related complications. Image-guided TRD is a safe and effective procedure with high technical and clinical success rates for the treatment of pelvic abscesses in children.

A case in which endoscopic ultrasound-guided transrectal drainage was effective for pelvic abscess

The patient, a 33-year-old female, presented to her local doctor with lower abdominal pain. She was referred to our hospital for a plain CT scan, which revealed signs of ileitis. Because acute appendicitis could not be ruled out, the patient was hospitalized. On the third day of hospitalization, she underwent laparoscopic appendicectomy for perforated appendicitis. However, the inflammatory response persisted despite continued antibacterial treatment; we diagnosed this to be due to the formation of a postoperative residual abscess. Since drainage of the abscess was deemed necessary, the patient underwent EUS-guided transrectal drainage on the 26th day of hospitalization. The patient had a favorable postoperative course and was discharged on the 31st day of hospitalization. Along with some literature review, this report details a case in which transrectal drainage under ultrasound endoscopy was effective in treating a pelvic abscess. We report a case of a pelvic abscess that was drained through the rectum under EUS guidance and an internal and external fistula tube was placed. The abscess resolved without complications.

EUS-guided transrectal drainage of pelvic abscesses: a retrospective analysis of 17 patients.

Pelvic abscess is a common complication of abdominal surgery or intestinal or gynecological diseases. Over the last decades, endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to percutaneous or surgical treatment of pelvic abscesses. To evaluate safety and efficacy of EUS-guided transrectal pelvic abscess drainage in a single center. From February 2017 to April 2023, all data on patients who were treated for pelvic abscesses by EUS-guided drainage in a single center, were retrospectively analyzed. A total of 17 patients were treated for pelvic abscesses by EUS-guided drainage. The procedure was technically successful and uneventful in all 17 patients (100%). Etiology of the abscess was postsurgical (n=5, 29%), secondary to medical illness (n=10, 59%) or gastrointestinal perforation (n=2, 12%). The abscess was multilocular in 5 patients (29%), the mean largest diameter was 76 mm (range 40-146 mm). Drainage was performed using 2 double pigtail stents, and in 1 patient an additional 10 Fr drainage catheter was deployed. Two patients (12%) required a second endoscopic intervention. Treatment success, defined by complete abscess resolution on follow-up CT scan along with symptom relief, was 100%. There was no need for surgical intervention. The median post-procedural hospital stay was 5 days. No recurrence was reported within a median time of follow-up of 39 months. EUS-guided transrectal drainage of pelvic abscesses using double pigtail stents is safe and highly effective. This case series contributes to the cumulative evidence that, in expert hands, EUS-guided drainage should be considered as first-line approach for treatment of pelvic abscesses.

EUS-guided transcolonic drainage and necrosectomy in walled-off necrosis: a retrospective, single-center case series.

Background and study aims Transgastric endoscopic ultrasound (EUS)-guided drainage and, if needed, necrosectomy is the preferred treatment in patients with pancreatic walled-off necrosis. EUS-guided transcolonic or transrectal drainage and necrosectomy may serve as a minimally invasive alternative in cases in which transgastric or percutaneous drainage is either impossible or fails to secure sufficient drainage. In this paper, we retrospectively evaluated the feasibility, safety, and efficacy of the treatment. We included nine patients and found a technical success rate of 100%, clinical success in 89%, and one adverse event (11%). Transrectal/transcolonic endoscopic necrosectomy was needed in seven patients (78%).

Abscess of the piriformis muscle in a 14-year old boy - a transrectal drainage method under transabdominal ultrasound guidance

IntroductionSciatica is a common reason for a medical consultation throughout the population. Piriformis pyomyositis is a rare cause of these symptoms. Its probable etiology is transient bacteraemia co-existing temporarily with a muscle injury.AimThe aim of the study is to present a method for treating a piriformis muscle abscess with transabdominal ultrasound-guided transrectal drainage.Case studyA 14-year old boy, previously healthy, was admitted with symptoms of sciatica that appeared after intense physical exertion. Laboratory tests revealed elevated inflammatory parameters and positive blood culture results indicating Staphylococcus aureus. Antibiotic therapy was implemented. MRI of the small pelvis revealed a forming abscess of the right piriformis muscle. On day 6 of the antibiotic therapy, in the absence of improvement, it was decided to perform transrectal drainage under ultrasound guidance. Clinical improvement was achieved, and the inflammatory parameters decreased.Results and discussionCo-existence of sciatica symptoms and signs of an inflammatory condition should prompt the consideration of piriformis pyomyositis. The mainstay of treatment for piriformis pyomyositis is antibiotic therapy. The abscess formation reduces its effectiveness, which necessitates surgical intervention. The authors present the application of transrectal drainage under transabdominal ultrasound guidance as the shortest route of abscess evacuation.ConclusionsTransrectal drainage of piriformis pyomyositis is an effective and safe method. Concomitant use of ultrasound scans reduces the patient’s exposure to ionising radiation. However, the widespread use of this method requires more in-depth research and broadened experience.

Emergency colectomy for acute severe ulcerative colitis: a nationwide survey on technical strategies of the Italian society of colorectal surgery (SICCR).

Emergency subtotal colectomy is the standard treatment for acute severe ulcerative colitis (ASUC) unresponsive to medical treatment. No guidelines are available about surgical technique. The aim of the current survey was to identify the attitudes of Inflammatory Bowel Disease (IBD) surgeons concerning colectomy in patients with ASUC by means of a nationwide survey, with specific focus on intraoperative technical details. A survey was developed with focus on number of procedures performed, approach to vascular ligation, technique of bowel dissection, treatment of the omentum and of the rectal stump. Twenty Centres completed the survey. Seventy percent of responders started the colectomy laparoscopically. No significant differences were observed about vessels and mesocolic dissection as well as on the choice of the starting colon side and management of the omentum. Ileocolic vessels were ligated distally by 70% and at the origin by 30% and those who transect mesenteric vessels distally are significatively more likely to perform the dissection from lateral to medial and to cut the middle colic vessels distally and 100% of the ones linking left vessels at mesenteric axis transect middle colic vessels at the origin. No differences were observed in the treatment of rectal stump; however, all surgeons who performed a transrectal drainage (45%) left the rectal stump intraperitoneal (p < 0.05). No consensus exists about the technique of dissection, vascular ligation, treatment of the omentum and management of rectal stump. Further studies are needed to evaluate the impact of the different surgical techniques on patients' outcomes.

Freehand endoscopic ultrasound-guided transrectal drainage of diverticulitis-associated abscess with electrocautery-enhanced lumen-apposing metal stent under spinal anesthesia.

Freehand endoscopic ultrasound-guided transrectal drainage of diverticulitis-associated abscess with electrocautery-enhanced lumen-apposing metal stent under spinal anesthesia.

Seminal vesicle abscess: A case report and review of the literature

Seminal vesicle abscess (SVA) is a rare pathology. We review the literature and present the case of a 54-year-old presenting with an SVA treated successfully with percutaneous transgluteal drainage and subsequently, transrectal ultrasound (TRUS)-guided transrectal drainage. Level of evidence: 4

Outcomes following anastomotic leak from rectal resections, including bowel function and quality of life.

Anastomotic leak (AL) is an uncommon but potentially devastating complication after rectal resection. We aim to provide an updated assessment of bowel function and quality of life after AL, as well as associated short- and long-term outcomes. A retrospective audit of all rectal resections performed at a colorectal unit and associated private hospitals over the past 10 years was performed. Relevant demographic, operative, and histopathological data were collected. A prospective survey was performed regarding patients' quality of life and fecal continence. These patients were matched with nonAL patients who completed the same survey. One hundred patients (out of 1,394 resections) were included. AL was contained in 66.0%, not contained in 10.0%, and only anastomotic stricture in 24.0%. Management was antibiotics only in 39.0%, percutaneous drainage in 9.0%, operative abdominal drainage in 19.0%, transrectal drainage in 6.0%, combination of percutaneous drainage and transrectal drainage in 2.0%, and combination abdominal/transrectal drainage in 1.0%. The 1-year stoma rate was 15.0%. Overall, mean Fecal Incontinence Severity Instrument scores were higher for AL patients than their matched counterparts (8.06±10.5 vs. 2.92±4.92, P=0.002). Patients with an AL had a mean EuroQol visual analogue scale (EQ-VAS) of 76.23±19.85; this was lower than the matched mean EQ-VAS for non-AL patients of 81.64±18.07, although not statistically significant (P=0.180). The majority of AL patients in this study were managed with antibiotics only. AL was associated with higher fecal incontinence scores in the long-term; however, this did not equate to lower quality of life scores.

Safety and Efficiency of Prostatic Abscess Transgluteal Drainage: A Case Report and Review of the Literature

AbstractProstatic abscess (PA) is an uncommon disorder that mainly affects diabetic and immunocompromised patients. It requires a high index of suspicion for diagnosis since it can clinically mimic acute prostatitis. Historically, transurethral drainage along with antimicrobial therapy has been the gold standard therapy. However, advances in imaging modalities have shifted the management of PA to less invasive approaches. Here, we present a case of a large PA drained by the percutaneous transgluteal approach. This access route is a safe, effective, and well tolerated alternative for PA drainage, done under local anesthesia and providing a relatively cleaner approach than transrectal or transperineal drainage, allowing easier and better catheter fixation as well. This article illustrates the different steps of the procedure and reviews the literature on PA management.

Abstract No. 475 Between a Rock and a hard place: transgluteal versus transrectal drainage catheter pain scores

Abstract No. 475 Between a Rock and a hard place: transgluteal versus transrectal drainage catheter pain scores

Transrectal endoscopic drainage with vacuum-assisted therapy in patients with anastomotic leaks following rectal cancer resection

BackgroundSurgery is the gold standard for the treatment of malignant tumors of the rectum. Intestinal anastomotic leakage remains a serious complication of colorectal surgery. The efficacy and safety of transrectal endoscopic drainage by vacuum therapy in patients with intestinal anastomotic leakage after surgical treatment of middle and distal rectal tumors were assessed.MethodsProspective analysis of treatment outcomes among patients undergoing surgery for middle and distal rectal tumors at the Department of General, Gastroenterological, and Oncological Surgery of the Ludwik Rydygier Collegium Medicum in Bydgoszcz and Nicolaus Copernicus University in Torun from 2016 to 2019 was conducted.ResultsSeventy-nine patients with middle and distal rectal tumors underwent laparoscopic resection. Intestinal anastomotic leak was identified in 18 (22.79%) patients [all men, mean age 61.39 (43–86) years] during the postoperative period. Primary protective ileostomy was performed in 8/18 (44.44%) patients. All 18 patients were treated with endoluminal vacuum therapy via transrectal endoscopic drainage. The mean time from surgery to the diagnosis of leakage and initiation of endoscopic treatment was 16 (3–728) days. The mean number of endoscopic procedures per patient was 6 (1–11). The mean duration of endoscopic treatment was 22 (4–43) days. Complications of endotherapy occurred in 2/18 (11.11%) patients treated endoscopically for bleeding from the abscess cavity. Success of endoluminal vacuum therapy was achieved in 17/18 (94.44%) patients. Moreover, 5/18 (27.78%) patients required ileostomy during the endoscopic treatment. The mean follow-up period was 368 (118–724) days. Long-term success of transrectal endoscopic drainage using vacuum-assisted therapy was achieved in 15/18 (83.33%) patients.ConclusionsEndoscopic rectal drainage using vacuum-assisted therapy is an effective and safe minimally invasive treatment in patients with intestinal anastomotic leaks following resection procedures within the middle and distal rectum.

Safety of Transrectal or Transvaginal Drainage of Pelvic Abscesses

AbstractObjective The literature on the safety and long-term sequelae of transrectal and transvaginal drainage of pelvic abscesses is limited. We evaluated the outcomes and safety of pelvic abscess drainage by interventional radiology at our institution.Methods After obtaining institutional review board approval, we retrospectively evaluated the outcomes of transrectal and transvaginal pelvic abscesses drainage using computed tomography, endorectal ultrasound, and or fluoroscopy.Results The study included 26 patients, with an age range of 24 to 88 years old, out of whom 53.8% were men. A total of 46.1% of the participants were African Americans and 26.9% were Caucasians. The average body mass index was 28.4 (range: 15.6 to 41.9). The most common etiology was penetrating abdominal injury (27%), followed by appendectomy (23%), diverticular disease (11.5%), anastomotic leak (11.5%), and disorders of gynecological causes (11.5%). The mean abscess diameter was 6.3 cm (range: 3.3 to 10.0 cm). Transrectal drainage was performed in all except one patient who had a transvaginal drainage. Transrectal ultrasound was used for drainage in 92.3% cases, and fluoroscopy was used as an additional imaging modality in 75% of the cases. An 8- or 10-Fr pigtail catheter was used in &gt; 80% of the patients. Drains were removed between 2 and 7 days in 92.3% of the cases. The average follow-up was 30.4 months (range: 1 to 107 months), and no long-term complications were reported. Only one patient required subsequent operative intervention for an anastomotic leak.Conclusions Pelvic abscess drainage by transrectal route using radiological guidance is a safe and effective procedure.

A Pediatric Case of Successful Endoscopic Ultrasound-Guided Transrectal Drainage of a Pelvic Abscess

A Pediatric Case of Successful Endoscopic Ultrasound-Guided Transrectal Drainage of a Pelvic Abscess

A Case Report of Abscess Formation Type Appendicitis Treated Using Endoscopic Ultrasonography Guided Transrectal Drainage in a 13-year-old Boy

A Case Report of Abscess Formation Type Appendicitis Treated Using Endoscopic Ultrasonography Guided Transrectal Drainage in a 13-year-old Boy

Une prostatite granulomateuse abcédée

Prostatic abscesses are usually diagnosed in the setting of bacterial prostatitis. Rarely, they reveal or complicate granulomatous prostatitis. A 55-year-old man was admitted for acute urinary retention. Urine culture was sterile, with leukocyturia > 106/ml. After failure of antibiotic therapy with cefotaxime, CT scan revealed a necrotic prostatic collection and a nodular non-necrotic tissular lesion in the left upper lung lobe. Trans-rectal drainage of the prostatic lesion and lung biopsies revealed granuloma with multinucleated giant cells (without mycobacteria). The diagnosis of granulomatosis with polyangiitis was confirmed by high level of anti-proteinase 3 antibodies. Treatment with steroids and rituximab resulted in apyrexia, regression of the inflammatory syndrome and clinical manifestations. The diagnosis of granulomatosis with polyangiitis should be considered in the presence of a non-infectious granulomatous prostatitis with systemic involvement.

EUS-guided transrectal drainage of pelvic fluid collections using electrocautery-enhanced lumen-apposing metal stents: a case series.

Background and AimsPelvic fluid collections (PFCs) are frequent adverse events of abdominal surgery or inflammatory conditions. A percutaneous approach to deep PFCs could be challenging and result in a longer, painful recovery. The transvaginal approach has been considered easy but is limited by the difficulty of leaving a stent in place. The transrectal approach has been described, but issues related to fecal contamination were hypothesized. Data on EUS-guided transrectal drainage (EUS-TRD) with lumen-apposing metal stents (LAMSs) are few and suggest unsatisfactory outcomes. The aim of this study was to evaluate the safety and efficacy of EUS-TRD with LAMSs in patients with PFCs.MethodsA retrospective analysis of a prospectively maintained database on therapeutic EUS was conducted. All EUS-TRD procedures were included.ResultsFive patients (2 male, age 44-89 years) were included. Four patients had postoperative PFCs, and 1 presented with a pelvic abscess complicating acute diverticulitis. Two of 5 had fecal diversion; the remaining 3 had unaltered large-bowel anatomy. One case had a concomitant abdominal collection, treated with percutaneous drainage in the same session. An electrocautery-enhanced LAMS delivery system (15 × 10 mm) was used in all cases. EUS-TRD was performed with the direct-puncture technique and lasted less than 10 minutes in 4 cases; in the remaining case, needle puncture and LAMS placement over a guidewire was required, and the procedure length was 14 minutes. The clinical success rate was 100%. LAMSs were removed after a median of 14 (range, 12-24) days. One patient reported partial proximal LAMS migration after 24 days (mild adverse event). No PFC recurrence was observed.ConclusionEUS-TRD with LAMSs is a safe and effective technique for treatment of PFCs. The use of 15- × 10-mm LAMSs allows rapid PFC resolution. EUS-TRD could be performed not only in patients with fecal diversion but also in cases of unaltered anatomy.

2199 Endoscopic Ultrasound-Guided Transrectal Drainage of a Tubo-Ovarian Abscess via a Lumen-Apposing Metal Stent

INTRODUCTION: Tubo-ovarian abscess (TOA) is a potentially lethal condition requiring a combination of medical and surgical intervention. Endoscopic ultrasound (EUS)-guided drainage is a known modality for safe and effective management of pelvic collections, but its role in TOA drainage is not well documented. We present a case of a TOA treated successfully with EUS-guided transrectal drainage using a lumen apposing metal stent (LAMS). CASE DESCRIPTION/METHODS: A 45-year-old woman presented to the hospital with a 4-day history of left lower quadrant abdominal pain. Her medical history included a right-sided TOA treated with antibiotics one year ago, type II diabetes mellitus, and obesity. She was tachycardic and tachypneic on arrival with a leukocytosis and elevated inflammatory markers. Computed tomography (CT) revealed a 11.3 × 10.3 × 9.4 cm complex cystic structure within the left adnexa consistent with a TOA (Image 1). Due to worsening leukocytosis and abdominal pain, interventional radiology was consulted but could not find a safe window for percutaneous drainage. A rectal EUS subsequently revealed a 50 × 45 mm abscess 20 cm from the anal verge (Image 2). A 19-gauge EZ-Shot 3 FNA needle was advanced with return of purulent fluid. After injection of 15 cc ionic contrast to delineate the abscess and confirm positioning, EUS-guided transrectal drainage of the TOA with placement of a 15 × 10 mm AXIOS stent (Boston Scientific, Marlborough, MA, USA) was successfully performed. The distal flange was deployed within the abscess cavity and the proximal flange was deployed within the rectal lumen with copious amounts of purulent drainage through the AXIOS stent (Image 3). Repeat CT performed one week later revealed significant interval decrease in the size of the TOA. DISCUSSION: EUS-guided drainage of pelvic collections has been established as a lower-risk alternative to surgical interventions, especially for collections greater than 4 cm and within a 1-2 cm reach of the EUS transducer. Furthermore, use of LAMS can facilitate drainage through a wider conduit, promoting rapid evacuation and source control. To our knowledge, this is the first reported case of successful EUS-guided transrectal drainage of a TOA using a LAMS.