Published online Aug 16, 2014. doi: 10.4253/wjge.v6.i8.373
Revised: June 5, 2014
Accepted: June 27, 2014
Published online: August 16, 2014
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.
Core tip: For pelvic abscesses that are not amenable to percutaneous drainage, EUS-guided drainage affords a safe and efficient alternative method. The procedure was performed in eight patients under conscious sedation and without a radiological monitoring. One or two plastic stents (7 Fr) were placed after dilatation of the tract with a balloon in four patients. Revising this technique by using a cystotome in other four patients appeared feasible and without adverse events. Abscess resolution was documented by imaging examination in all patients. This outcome was not affected although spontaneous stent dislodgment or migration occurred in the majority of patients.