Deep pelvic abscesses: transperineal US-guided drainage.
OBJECTIVE
To examine the efficacy of transperineal sonographically guided drainage of deep pelvic abscesses.


METHODS
Twelve drainage procedures were performed in 11 adults with symptoms of infection and cross-sectional images demonstrating a deep pelvic abscess. Eight patients had recently undergone abdominoperineal resection, seven of whom underwent preoperative radiation therapy. Two had chronic osteomyelitis with adjacent fluid collections, and one developed an infected hematoma after trauma. With ultrasound (US) guidance for initial access, catheters were placed for drainage in 11 procedures. One patient was treated with aspiration alone. Patients underwent clinical follow-up and subsequent imaging as necessary.


RESULTS
Transperineal needle placement was successful in 12 of 12 patients (100%). In procedures that required catheter placement, 10 of 11 placements (91%) were achieved with the transperineal approach. One patient required fluoroscopic transvaginal catheter placement after opacification of the collection transperineally. Catheter drainage was maintained for 2-146 days (mean, 40 days; median, 21 days). Clinical success was achieved in nine of 10 patients (90%) by means of transperineal drainage. There were no complications, although premature catheter removal occurred in two patients.


CONCLUSIONS
US-guided transperineal abscess drainage may be successfully performed in patients who cannot undergo conventional transabdominal, transvaginal, or transrectal catheter drainage.
Sperling
D C
DC
Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, Philadelphia, PA 19107, USA.
Needleman
L
L
Eschelman
D J
DJ
Hovsepian
D M
DM
Lev-Toaff
A S
AS
D000005:Abdomen / Q000601:surgery; D000038:Abscess / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D002404:Catheterization / Q000295:instrumentation; D002908:Chronic Disease; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000601:surgery; D010388:Pelvis / Q000000981:diagnostic imaging / Q000601:surgery*; D010502:Perineum / Q000601:surgery; D011878:Radiotherapy; D013396:Suction; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional