Muhammed Hadithi1, Marco J Bruno1. 1. Muhammed Hadithi, Department of Gastroenterology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands.
Abstract
AIM: To show the safety and effectiveness of endoscopic ultrasound (EUS)-guided drainage of pelvic abscess that were inaccessible for percutaneous drainage. METHODS: Eight consecutive patients with pelvic abscess that were not amenable to drainage under computed tomography (CT) guidance were referred for EUS-guided drainage. The underlying cause of the abscesses included diverticulitis in 4, postsurgical surgical complications in 2, iatrogenic after enema in 1, and Crohn's disease in 1 patient. Abscesses were all drained under EUS guidance via a transrectal or transsigmoidal approach. RESULTS: EUS-guided placement of one or two 7 Fr pigtail stents was technically successful and uneventful in all 8 patients (100%). The abscess was perisigmoidal in 2 and was multilocular in 4 patients. All procedures were performed under conscious sedation and without fluoroscopic monitoring. Fluid samples were successfully retrieved for microbiological studies in all cases and antibiotic policy was adjusted according to culture results in 5 patients. Follow-up CT showed complete recovery and disappearance of abscess. The stents were retrieved by sigmoidoscopy in only two patients and had spontaneously migrated to outside in six patients. All drainage procedures resulted in a favourable clinical outcome. All patients became afebrile within 24 h after drainage and the mean duration of the postprocedure hospital stay was 8 d (range 4-14). Within a median follow up period of 38 mo (range 12-52) no recurrence was reported. CONCLUSION: We conclude that EUS-guided drainage of pelvic abscesses without fluoroscopic monitoring is a minimally invasive, safe and effective approach that should be considered in selected patients.
AIM: To show the safety and effectiveness of endoscopic ultrasound (EUS)-guided drainage of pelvic abscess that were inaccessible for percutaneous drainage. METHODS: Eight consecutive patients with pelvic abscess that were not amenable to drainage under computed tomography (CT) guidance were referred for EUS-guided drainage. The underlying cause of the abscesses included diverticulitis in 4, postsurgical surgical complications in 2, iatrogenic after enema in 1, and Crohn's disease in 1 patient. Abscesses were all drained under EUS guidance via a transrectal or transsigmoidal approach. RESULTS: EUS-guided placement of one or two 7 Fr pigtail stents was technically successful and uneventful in all 8 patients (100%). The abscess was perisigmoidal in 2 and was multilocular in 4 patients. All procedures were performed under conscious sedation and without fluoroscopic monitoring. Fluid samples were successfully retrieved for microbiological studies in all cases and antibiotic policy was adjusted according to culture results in 5 patients. Follow-up CT showed complete recovery and disappearance of abscess. The stents were retrieved by sigmoidoscopy in only two patients and had spontaneously migrated to outside in six patients. All drainage procedures resulted in a favourable clinical outcome. All patients became afebrile within 24 h after drainage and the mean duration of the postprocedure hospital stay was 8 d (range 4-14). Within a median follow up period of 38 mo (range 12-52) no recurrence was reported. CONCLUSION: We conclude that EUS-guided drainage of pelvic abscesses without fluoroscopic monitoring is a minimally invasive, safe and effective approach that should be considered in selected patients.
Authors: L Brusciano; V Maffettone; V Napolitano; G Izzo; G Rossetti; D Izzo; F Russo; G Russo; G del Genio; A del Genio Journal: Ann Ital Chir Date: 2004 Sep-Oct Impact factor: 0.766