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Pelvic abscess associated with anastomotic leak in patients with ileal pouch-anal anastomosis (IPAA): transanastomotic or CT-guided drainage?

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Abstract

Aim

Evidence is lacking whether an abscess associated with anastomotic leak after an ileal pouch-anal anastomosis (IPAA) should be drained by transanal or CT-guided drainage. Therefore, the aim of this study was to compare outcomes after the two techniques for drainage.

Method

Patients who underwent IPAA (1984–2009) and diagnosed with a pelvic abscess associated with an anastomotic leak were identified. The choice of operative or image-guided drainage was based on surgeon preference. Differences between patients undergoing transanal (group TA) and CT-guided drainage (group CT) were determined.

Results

Groups TA (n = 53) and CT (n = 18) had similar age (p = 0.3), gender (p = 0.3), body mass index (p = 0.6), steroid use (p = 0.4), albumin level (p = 0.9), ileostomy (p = 0.6), and follow-up time (p = 0.5). The size of the abscess was greater in group CT (p = 0.012). Two patients developed fistula at the CT-guided drainage site. Both healed after conservative treatment and drainage of associated gluteal abscess, respectively. Thirteen patients in group TA and three patients in group CT (p = 0.6) had failure of drainage and underwent surgery. The success rates for the procedures in terms of long-term pouch retention were 75.5% and 83%, respectively, for TA and CT. Groups TA and CT had similar bowel frequency (p = 0.9), incontinence (p = 0.6), urgency (p = 0.9), seepage (p = 0.6), pad usage (p = 0.1), quality of life (p = 0.9), and happiness with surgery (p = 0.9).

Conclusions

There is a risk of fistula at drainage site after a CT-guided drainage of the pelvic abscess associated with anastomotic leak following IPAA. Transanal and CT-guided drainage are equally effective and result in similar long-term pouch-related outcomes.

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Abbreviations

IPAA:

Ileal pouch-anal anastomosis

UC:

Ulcerative colitis

FAP:

Familial adenomatous polyposis

QOL:

Quality of life

CGQL:

Cleveland Global Quality of Life

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Conflicts of interest

The authors declare no commercial conflict of interest.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA

    Hasan Tarik Kirat, Feza H. Remzi & Ravi P. Kiran

  2. Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Bo Shen

Authors
  1. Hasan Tarik Kirat
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  2. Feza H. Remzi
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  3. Bo Shen
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  4. Ravi P. Kiran
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Correspondence to Ravi P. Kiran.

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Kirat, H.T., Remzi, F.H., Shen, B. et al. Pelvic abscess associated with anastomotic leak in patients with ileal pouch-anal anastomosis (IPAA): transanastomotic or CT-guided drainage?. Int J Colorectal Dis 26, 1469–1474 (2011). https://doi.org/10.1007/s00384-011-1272-y

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  • DOI: https://doi.org/10.1007/s00384-011-1272-y

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