title: Pelvic abscess associated with anastomotic leak in patients with ileal pouch-anal anastomosis (IPAA): transanastomotic or CT-guided drainage?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Hasan Tarik
authors.initials: HT
authors.lastname: Kirat
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology*; D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology*; D039021:Colonic Pouches / Q000009:adverse effects*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology*; D011788:Quality of Life; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome