J Korean Soc Radiol.  2010 Apr;62(4):343-349. 10.3348/jksr.2010.62.4.343.

Percutaneous Drainage of Postoperative Pelvic Abscess: Fluoroscopic and US-Guided Transgluteal Approach

• Lim HJ
• Hong HP
• Lee HG
• Choi YJ
• Lee YR
• Lee JY
• Park HW
• Kim SS

• KMID: 1460066
• DOI: http://doi.org/10.3348/jksr.2010.62.4.343

Abstract

PURPOSE
To retrospectively review the effectiveness and safety of fluoroscopic and US-guided percutaneous transgluteal drainage of postoperative pelvic abscesses.
MATERIALS AND METHODS
From January 2002 to December 2007, 594 patients underwent surgery at our institution due to rectosigmoid cancer. A retrospective analysis revealed that percutaneous drainage of a postoperative pelvic abscess was performed in 19 out of the 594 patients (3.19%) that underwent surgery (13 male, 6 female; mean age, 57.9 years; age range, 40-82 years). The transgluteal and other methods were used for percutaneous drainage and the success rate, duration of therapy, and complication rate were evaluated.
RESULTS
The transgluteal approach was performed with fluoroscopic and US-guidance in 10 patients (52.6%). A catheter was inserted through a preexisting surgical drain in 5 patients (26.3%). The transabdominal approach was performed under US-guidance in 4 patients (21.0%). Technical success was achieved in all patients. The catheter was removed after a mean of 14 days. In 2 patients, who were treated by the transgluteal apporoach, subsequent surgery was performed due to incomplete resolution of the abscess (10.5%). The mean duration of catheter drainage using the transgluteal approach (16.5 days) was longer than other methods (11.2 days). Furthermore, no procedure-related major complications or mortality was observed in all methods.
CONCLUSION
The percutaneous transgluteal approach to a postoperative pelvic abscess with US and fluoroscopic guidance is relatively safe and effective.

MeSH Terms

Abscess
Catheters
Drainage
Humans
Male
Pelvis
Radiology, Interventional
Retrospective Studies

Figure

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  Fig. 1 A 40-year-old man with pelvic abscess. A. CT scan through mid pelvis shows cephalic portion of the greater sciatic foramen. superior gluteal vessel (sgvs) and sciatic nerve (scn) coursing through the upper portion of the greater sciatic foramen (gsf). ub = urinary bladder, sgvs = superior gluteal vessels, scn = sciatic nerve, gsf = greater sciatic foramen, prf = piriformis muscle B. CT scan through the caudal portion of the greater sciatic foramen shows sacrospinous ligament (ssl). Note the internal pudendal vessels (ipvs) and inferior gluteal vessels (igvs) located lateral aspect of the greater sciatic foramen (gsf). There were also noted abscess (a) in presacral area. p = prostate, oi = obturator internus muscle

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  Fig. 2 40-year-old man diagnosed and treated for rectal adenocarcinoma developed fever and leukocytosis 10 days after surgery. A. Axial CT image shows a fluid collection with air bubbles at presacral space (*) above anastomosis site. Arrow indicates direction of Chiba needle. B. 10.2 F pigtail catheter was inserted successfully into the presacral abscess by fluoroscopic and US-guided transgluteal approach. C. 2 months after, follow up CT shows 10.2 F drainage catheter which traverse the sacrospinous ligament (arrow). Inferior gluteal vessels (arrowhead) are seen more lateral aspect of the catheter. Note the decreased size of the presacral abscess.

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  Fig. 3 59-year-old man diagnosed and treated for rectal neuroendocrine carcinoma developed fever and abdominal pain 6 months after surgery A. Axial CT image show fluid collection at presacral space (*). Arrow indicates direction of Chiba needle. B. 18 G Chiba needle was inserted into presacral abscess by fluoroscopic and US-guided transgluteal approach. C. 10.2 F drainage catheter was inserted successfully.

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