title: A novel approach for the treatment of pelvic abscess: transrectal endoscopic drainage facilitated by transanal endoscopic microsurgery access.
abstract: BACKGROUND
  Postoperative pelvic abscesses in patients submitted to colorectal surgery are challenging. The surgical approach may be too risky, and image-guided drainage often is difficult due to the complex anatomy of the pelvis. This article describes novel access for drainage of a pelvic collection using a minimally invasive natural orifice approach.
  
  
  METHODS
  A 37 year-old man presented with sepsis due to a pelvic abscess during the second postoperative week after a Hartmann procedure due to perforated rectal cancer. Percutaneous drainage was determined by computed tomography to be unsuccessful, and another operation was considered to be hazardous. Because the pelvic fluid was very close to the rectal stump, transrectal drainage was planned. The rectal stump was opened using transanal endoscopic microsurgery (TEM) instruments. The endoscope was advanced through the TEM working channel and the rectal stump opening, accessing the abdominal cavity and pelvic collection.
  
  
  RESULTS
  The pelvic collection was endoscopically drained and the local cavity washed with saline through the scope channel. A Foley catheter was placed in the rectal stump. The patient's recovery after the procedure was successful, without the need for further intervention.
  
  
  CONCLUSIONS
  Transrectal endoscopic drainage may be an option for selected cases of pelvic fluid collection in patients submitted to Hartmann's procedure. The technique allows not only fluid drainage but also visualization of the local cavity, cleavage of multiloculated abscesses, and saline irrigation if necessary. The use of TEM instrumentation allows safe access to the peritoneal cavity.
authors.affiliation: Department of Gastroenterology, Cancer Institute, São Paulo University, Av. Dr. Arnaldo, 251, São Paulo 01246-000, Brazil. bcm.bruno@gmail.com
authors.forename: B C
authors.initials: BC
authors.lastname: Martins
authors.forename: Carlos Frederico Sparapan
authors.initials: CF
authors.lastname: Marques
authors.forename: Caio Sérgio Rizkallah
authors.initials: CS
authors.lastname: Nahas
authors.forename: Fábio Yuji
authors.initials: FY
authors.lastname: Hondo
authors.forename: Wilson
authors.initials: W
authors.lastname: Pollara
authors.forename: Sérgio Carlos
authors.initials: SC
authors.lastname: Nahas
authors.forename: U
authors.initials: U
authors.lastname: Ribeiro Junior
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
authors.forename: Fauze
authors.initials: F
authors.lastname: Maluf-Filho
mesh_terms: D018784:Abdominal Abscess / Q000601:surgery*; D000328:Adult; D001003:Anal Canal; D004322:Drainage / Q000379:methods*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery; D010388:Pelvis; D012007:Rectum