Abstract
Aim
Percutaneous drainage of abdominal and pelvic abscesses is a first-line alternative to surgery. Anterior and lateral approaches are limited by the presence of obstacles, such as the pelvic bones, bowel, bladder, and iliac vessels. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous, transgluteal approach by reviewing our clinical experience and the literature.
Materials and methods
We reviewed demographic, clinical and morphological data in the medical records of 30 patients having undergone percutaneous, computed tomography (CT)-guided, transgluteal drainage. In particular, we studied the duration of catheter drainage, the types of microorganisms in biological fluid cultures, complications related to procedures and the patient’s short-term treatment outcome.
Results
From January 2005 to October 2011, 345 patients underwent CT-guided percutaneous drainage of pelvis abscesses in our institution. A transgluteal approach was adopted in 30 cases (10 women and 20 men; mean age: 52.6 [range 14–88]). The fluid collections were related to post-operative complications in 26 patients (86.7 %) and inflammatory or infectious intra-abdominal disease in the remaining 4 patients (acute diverticulitis: n = 2; appendicitis: n = 1; Crohn’s disease: n = 1) (13.3 %). The mean duration of drainage was 8.7 days (range 3–33). Laboratory cultures were positive in 27 patients (90 %) and Escherichia coli was the most frequently present microorganism (in 77.8 % of the positive samples). A transpiriformis approach (n = 5) was more frequently associated with immediate procedural pain (n = 3). No major complications were observed, either during or after the transgluteal procedure. Drainage was successful in 29 patients (96.7 %). One patient died from massive, acute cerebral stroke 14 days after drainage.
Conclusion
When an anterior approach is unfeasible, transgluteal, percutaneous, CT-guided drainage is a safe, well tolerated and effective procedure. Major complications are rare. This type of drainage is an alternative to surgery for the treatment of deep pelvic abscesses (especially for post-surgical collections).
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cinat ME, Wilson SE, Din AM (2002) Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg 137:845–849
Men S, Akhan O, Köroglu M (2002) Percutaneous drainage of abdominal abscess. Eur J Radiol 43:204–218
Gervais DA, Hahn PF, O’Neill MJ, Mueller PR (2000) CT-guided transgluteal drainage of deep pelvic abscesses in children: selective use as an alternative to transrectal drainage. AJR Am J Roentgenol 175:1393–1396
Harisinghani MG, Gervais DA, Hahn PF, et al. (2002) Radiographics 22:1353–1367
Maher MM, Gervais DA, Kalra MK, et al. (2004) The inaccessible or undrainable abscess: how to drain it. Radiographics 24:717–735
Butch RJ, Mueller PR, Ferruci JT, et al. (1986) Drainage of pelvic abscesses through the greater sciatic foramen. Radiology 158:487–491
Harisinghani MG, Gervais DA, Maher MM, et al. (2003) Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology 228:701–705
Ryan RS, McGrath FP, Haslam PJ, Varghese JC, Lee MJ (2003) Ultrasound-guided endocavitary drainage of pelvic abscesses: technique, results and complications. Clin Radiol 58:75–79
Bennett JD, Kozak RI, Taylor BM, Jory TA (1992) Deep pelvic abscesses: transrectal drainage with radiologic guidance. Radiology 185:825–828
VanSonnenberg E, D’Agostino HB, Casola G, et al. (1991) US-guided transvaginal drainage of pelvic abscesses and fluid collection. Radiology 181:53–55
Varghese JC, O’Neill MJ, Gervais DA, Boland GW, Mueller PR (2001) Transvaginal catheter drainage of tuboovarian abscess using the trocar method: technique and literature review. AJR Am J Roentgenol 177:139–144
Walser E, Raza S, Hernandez A, et al. (2003) Sonographically guided transgluteal drainage of pelvic abscesses. AJR Am J Roentgenol 181:498–500
Aubé C, Haghbin H, Lebigot J, et al. (2004) Value of the transgluteal approach under CT-guidance for percutaneous interventional image guided procedures. J Radiol 85:117–123
Soyer P, Boudiaf M, Alves A, et al. (2005) CT-guided transgluteal approach for percutaneous drainage of pelvic abscesses: results in 21 patients. Ann Chir 130:162–168
Shah H, Harris VJ (1997) Saline injection into the perirectal space to assist transgluteal drainage of deep pelvic abscesses. J Vasc Interv Radiol 8:119–121
Van Doesburg IAJ, Boerma D, Bollen TL, Van Ramshorst B, Wiezer MJ (2009) Large gluteal abscesses as a complication of transgluteal drainage of pelvic abscesses: analysis of the three cases and a search of the literature. Dig Surg 26:329–332
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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. Abdom Imaging 38, 285–289 (2013). https://doi.org/10.1007/s00261-012-9917-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-012-9917-z