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Jalloul RJ, Thomas M, Ward C, Pedroza C. Clinical predictors of failed medical treatment in patients with Tubo-Ovarian Abscess: External validation of a recently published risk score. J Minim Invasive Gynecol 2022; 29:649-655. [DOI: 10.1016/j.jmig.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
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Reitano E, de'Angelis N, Bianchi G, Laera L, Spiliopoulos S, Calbi R, Memeo R, Inchingolo R. Current trends and perspectives in interventional radiology for gastrointestinal cancers. World J Radiol 2021; 13:314-326. [PMID: 34786187 PMCID: PMC8567440 DOI: 10.4329/wjr.v13.i10.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/12/2021] [Accepted: 10/15/2021] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal (GI) cancers often require a multidisciplinary approach involving surgeons, endoscopists, oncologists, and interventional radiologists to diagnose and treat primitive cancers, metastases, and related complications. In this context, interventional radiology (IR) represents a useful minimally-invasive tool allowing to reach lesions that are not easily approachable with other techniques. In the last years, through the development of new devices, IR has become increasingly relevant in the context of a more comprehensive management of the oncologic patient. Arterial embolization, ablative techniques, and gene therapy represent useful and innovative IR tools in GI cancer treatment. Moreover, IR can be useful for the management of GI cancer-related complications, such as bleeding, abscesses, GI obstructions, and neurological pain. The aim of this study is to show the principal IR techniques for the diagnosis and treatment of GI cancers and related complications, as well as to describe the future perspectives of IR in this oncologic field.
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Affiliation(s)
- Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, University of Eastern Piedmont, Novara 28100, Italy
| | - Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Giorgio Bianchi
- Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Letizia Laera
- Department of Oncology, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Athens 12461, Greece
| | - Roberto Calbi
- Department of Radiology, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
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Gkrozou F, Tsonis O, Daniilidis A, Navrozoglou I, Paschopoulos M. Tubo-ovarian abscess: Exploring optimal treatment options based on current evidence. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520960649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose: Tubo-ovarian abscess (TOA) and pelvic abscess are characterized by an inflammatory pelvic mass. In the majority of cases, this condition involves the ovaries, the fallopian tubes and/or any other adjacent tissue. TOA is considered a severe complication of PID and can cause severe sepsis. The main risk factors for women’s health are the size of the abscess, the initial amount of white blood cells (WBC), patients’ age as well as, any co-existing comorbidities. Methods: This study provides a review of the current literature regarding the management of TOA and the different criteria used in order to establish the optimal therapeutic approach or to predict outcome by individualizing cases. Four major search engines, MEDLINE, Google Scholar, PubMed and EMBASE, up to February 2020 were explored, focusing in epidemiology and risk factors, pathogenesis, diagnosis and treatment. Results: Our review suggests that there are no clear guidelines for best practice, in case of TOA, but it appears that intravenous antibiotics combined with interventional radiology have good results for TOA <5 cm. When TOA is >5 cm, laparoscopic approach is indicated. Further studies are needed in order to evaluate the best treatment for women with TOA. Conclusions: More prospective studies on large-series of patients are in need, in order to determine a clear pathway and to suggest specific criteria, which can guide clinicians to choose optimal approach in a timely manner.
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Affiliation(s)
- Fani Gkrozou
- Department of Obstetrics and Gynaecology, University Hospitals of Birmingham, Birmingham, UK
| | - Orestis Tsonis
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
| | - Aggelos Daniilidis
- 2nd Department of Obstetrics and Gynaecology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Navrozoglou
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
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Fouks Y, Cohen A, Shapira U, Solomon N, Almog B, Levin I. Surgical Intervention in Patients with Tubo-Ovarian Abscess: Clinical Predictors and a Simple Risk Score. J Minim Invasive Gynecol 2019; 26:535-543. [DOI: 10.1016/j.jmig.2018.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/18/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022]
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5
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Abstract
Percutaneous abscess drainage (PAD) has been proven to be a safe, effective, and widely used technique for treatment of patients with intra-abdominal fluid collections. Indications for PAD are ever expanding, and most abscesses are amenable to PAD. PAD is routinely used for treatment of simple unilocular abscesses however more complex collections require a collaborative strategy with surgical services for patient management. PAD is also used as a temporizing procedure for patients who will ultimately require operative intervention. A variety of imaging modalities are used for PAD including ultrasound and CT. Several catheter insertion techniques have proven effective. Complications from PAD are relatively uncommon.
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Percutaneous transgluteal drainage of pelvic abscesses in interventional radiology: A safe alternative to surgery. J Visc Surg 2016; 153:3-7. [DOI: 10.1016/j.jviscsurg.2015.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Patel BN, Morgan M, Tyler D, Paulson E, Jaffe TA. The role of CT-guided percutaneous drainage of loculated air collections: an institutional experience. ACTA ACUST UNITED AC 2015; 40:3257-64. [PMID: 26329977 DOI: 10.1007/s00261-015-0537-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study is to describe our experience with the role of CT-guided percutaneous drainage of loculated intra-abdominal collections consisting entirely of gas. MATERIALS AND METHODS An IRB-approved retrospective study analyzing patients with air-only intra-abdominal collections over an 8-year period was undertaken. Seven patients referred for percutaneous drainage were included. Size of collections, subsequent development of fluid, and microbiological yield were determined. Clinical outcome was also analyzed. RESULTS Out of 2835 patients referred for percutaneous drainage between 2004 and 2012, seven patients (5M, 2F; average age 63, range 54-85) met criteria for inclusion with CT showing air-only collections. Percutaneous drain placement (five 8 Fr, one 10 Fr, and one 12 Fr) using Seldinger technique was performed. Four patients (57%) had recently undergone surgery (2 Whipple, 1 colectomy, 1 hepatic resection) while two (29%) had a remote surgery (1 abdominoperineal resection, 1 sigmoidectomy). Despite the lack of detectable fluid on the original CT, 6 patients (86%) had air and fluid aspirated at drainage, 5 (83%) of the aspirates developed positive microbacterial cultures. Four patients (57%) presented with fever at the time of the initial scan, all of whom had positive cultures from aspirated fluid. Four patients (57%) had leukocytosis, all of whom had positive cultures from aspirated fluid. CONCLUSIONS Although relatively rare in occurrence, patients with air-only intra-abdominal collections with signs of infection should be considered for percutaneous management similar to that of conventional infected fluid collections. Although fluid is not visible on CT, these collections can produce fluid that contains organisms.
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Affiliation(s)
- Bhavik N Patel
- Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC, 27710, USA.
| | - Madeline Morgan
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Douglas Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Erik Paulson
- Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC, 27710, USA
| | - Tracy A Jaffe
- Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC, 27710, USA
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McDermott S, Levis DA, Arellano RS. Approaches to the difficult drainage and biopsy. Semin Intervent Radiol 2013; 29:256-63. [PMID: 24293798 DOI: 10.1055/s-0032-1330059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Percutaneous abscess drainage and percutaneous biopsy are effective and widely used techniques in the diagnosis and treatment of patients with abdominal or pelvic abscesses and lesions. Some abscesses and lesions can initially appear unsuitable for percutaneous access for a variety of reasons. This article reviews the circumstances in which collections or lesions may appear undrainable or inaccessible to percutaneous biopsy, and it describes techniques for overcoming these circumstances.
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Affiliation(s)
- Shaunagh McDermott
- Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Robert B, Chivot C, Fuks D, Gondry-Jouet C, Regimbeau JM, Yzet T. Percutaneous, computed tomography-guided drainage of deep pelvic abscesses via a transgluteal approach: a report on 30 cases and a review of the literature. ACTA ACUST UNITED AC 2013; 38:285-9. [PMID: 22684488 DOI: 10.1007/s00261-012-9917-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM Percutaneous drainage of abdominal and pelvic abscesses is a first-line alternative to surgery. Anterior and lateral approaches are limited by the presence of obstacles, such as the pelvic bones, bowel, bladder, and iliac vessels. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous, transgluteal approach by reviewing our clinical experience and the literature. MATERIALS AND METHODS We reviewed demographic, clinical and morphological data in the medical records of 30 patients having undergone percutaneous, computed tomography (CT)-guided, transgluteal drainage. In particular, we studied the duration of catheter drainage, the types of microorganisms in biological fluid cultures, complications related to procedures and the patient's short-term treatment outcome. RESULTS From January 2005 to October 2011, 345 patients underwent CT-guided percutaneous drainage of pelvis abscesses in our institution. A transgluteal approach was adopted in 30 cases (10 women and 20 men; mean age: 52.6 [range 14-88]). The fluid collections were related to post-operative complications in 26 patients (86.7 %) and inflammatory or infectious intra-abdominal disease in the remaining 4 patients (acute diverticulitis: n = 2; appendicitis: n = 1; Crohn's disease: n = 1) (13.3 %). The mean duration of drainage was 8.7 days (range 3-33). Laboratory cultures were positive in 27 patients (90 %) and Escherichia coli was the most frequently present microorganism (in 77.8 % of the positive samples). A transpiriformis approach (n = 5) was more frequently associated with immediate procedural pain (n = 3). No major complications were observed, either during or after the transgluteal procedure. Drainage was successful in 29 patients (96.7 %). One patient died from massive, acute cerebral stroke 14 days after drainage. CONCLUSION When an anterior approach is unfeasible, transgluteal, percutaneous, CT-guided drainage is a safe, well tolerated and effective procedure. Major complications are rare. This type of drainage is an alternative to surgery for the treatment of deep pelvic abscesses (especially for post-surgical collections).
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Affiliation(s)
- Brice Robert
- Department of Digestive Radiology, Amiens North Hospital, University of Picardy, Place Victor Pauchet, 80054, Amiens Cedex 01, France.
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10
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Abstract
The antibiotic treatment is indispensable for the treatment of the tubo-ovarian abscesses (TOA). It has to have a wide spectre and would be secondarily adapted in case of a sexually transmitted infection. The surgery remains indicated in first intention in case of vital threat (generalized peritonitis, toxic shock). In the not complicated TOA, the evacuation of abscesses (by draining under imaging or laparoscopy) with the antibiotic treatment gives better rates of cure than the antibiotic treatment alone. For the surgery, several entrys are possible. The laparoscopy allows a shorter hospitalization with fewer complications and a faster resolution of the fever than the laparotomy. The conservative surgery, realized by laparoscopy, has hight rates of successes with few complications. The radical surgery, by coelioscopy or by laparotomy, has high rates of complications. Transvaginal ultrasound guided aspiration is an alternative in the drainage by laparscopy with identical succes. It has been well evaluated. It has low morbidity and can be proposed in first intention in not complicated TOA.
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11
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Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol 2009; 23:667-78. [PMID: 19230781 DOI: 10.1016/j.bpobgyn.2009.01.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 01/05/2009] [Indexed: 01/09/2023]
Abstract
The optimum treatment for pelvic abscess would be an approach that is safe, efficacious, cost-effective, minimally invasive, and which affects the woman's fertility potential as little as possible. In women of reproductive age tubo-ovarian abscess is one of the most common types of pelvic abscess. Tubo-ovarian abscesses are classically treated with broad-spectrum antibiotics. Frequently this approach fails and surgical intervention becomes necessary in about 25% of all cases. Surgical procedures include laparotomy or laparoscopy with drainage of abscess, unilateral or bilateral salpingo-ophorectomy, and hysterectomy. However, surgery for tubo-ovarian abscess is often technically difficult and associated with complications. An alternative approach is the use of imaging-guided drainage of abscess in combination with antibiotics. Combined data from several studies indicate that ultrasound-guided transvaginal drainage with concomitant antibiotics is especially safe and efficacious. This chapter discusses the management of pelvic abscess with a special focus on transvaginal ultrasound-guided drainage of tubo-ovarian abscess.
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Affiliation(s)
- Seth Granberg
- Department of Obstetrics and Gynaecology, Akershus University Hospital, 1478 Lørenskog, Norway.
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12
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Sonographically Guided Transvaginal or Transrectal Pelvic Abscess Drainage Using the Trocar Method with a New Drainage Guide Attachment. AJR Am J Roentgenol 2008; 191:1540-4. [DOI: 10.2214/ajr.07.3830] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Golfieri R, Cappelli A. Computed tomography-guided percutaneous abscess drainage in coloproctology: review of the literature. Tech Coloproctol 2007; 11:197-208. [PMID: 17676271 DOI: 10.1007/s10151-007-0354-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Accepted: 03/04/2007] [Indexed: 12/28/2022]
Abstract
BACKGROUND Percutaneous abscess drainage (PAD) of the lower abdomen and pelvis has been reported to reduce morbidity and mortality, shorten hospital stay and cut costs compared to a surgical approach. However, the wide differences in outcome reported by different authors indicate the need for an overview and further evaluations. This review evaluates each point of the procedure to explain the possible causes for such discrepancies in results. METHODS We performed a PubMed search of outcomes for percutaneous abscesses drainage, focusing on deep pelvic collections, which represent the most difficult task, searching among papers published from 1981 to 2006. RESULTS Ninety-nine papers were selected. Most authors emphasized that the most important steps of the care process are: (a) patient selection; (b) indications and contraindications; (c) choice of the best access route; (d) procedure performance; and (e) outcome (success and complication rates). CONCLUSIONS PAD is a safe and effective alternative to surgery for draining deep infected fluid collections, with a higher success rate, lower complication rate and shorter hospital stay compared to surgical drainage. Meticulous technique and careful access planning seem to be the two most important factors affecting the outcome.
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Affiliation(s)
- R Golfieri
- Malpighi Radiology Unit Department of Digestive Diseases and Internal Medicine Policlinico Sant'Orsola-Malpighi, University of Bologna, Via Albertoni 15, I-40138, Bologna, Italy.
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Decroisette E, Raynal P, Le Meaux JP, Lepercq J, Aubard Y. Abcès primaire de l'ovaire. Diagnostic et approche thérapeutique. ACTA ACUST UNITED AC 2006; 34:337-40. [PMID: 16627000 DOI: 10.1016/j.gyobfe.2006.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 02/22/2006] [Indexed: 11/22/2022]
Abstract
Primary ovarian abscess is a rare infection. A new case has led us to carry out a literature review in order to optimize the treatment. Exceptionally isolated, primary ovarian abscess usually belongs to the postoperative complications. Nevertheless, its etiopathogenies are numerous. The symptoms are often poor; therefore the diagnosis is difficult to establish. The curative treatment must associate surgery and antibiotherapy. Even if laparoscopic surgery is the first line treatment in many cases, laparotomy remains the choice procedure. Ultrasonographically-guided evacuation has to be further evaluated. Preventive treatment is of major importance.
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Affiliation(s)
- E Decroisette
- Service de Gynécologie-Obstétrique, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France.
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Gjelland K, Ekerhovd E, Granberg S. Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: a study of 302 cases. Am J Obstet Gynecol 2005; 193:1323-30. [PMID: 16202721 DOI: 10.1016/j.ajog.2005.06.019] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Revised: 05/18/2005] [Accepted: 06/01/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Our purpose was to evaluate the effectiveness and safety of transvaginal ultrasound-guided aspiration together with antibiotic therapy for treatment of tubo-ovarian abscess. STUDY DESIGN A review of women treated with transvaginal ultrasound-guided aspiration for tubo-ovarian abscess at Haukeland University Hospital, Bergen, Norway, between June 1986 and July 2003 was performed. Immediate clinical response and longer-term follow-up results were assessed. RESULTS A total of 449 transvaginal aspirations were performed on 302 women. A total of 282 women (93.4%) were successfully treated for transvaginal aspiration of purulent fluid, together with antibiotic therapy. In the other 20 women (6.6%), surgery was performed. The main indications for surgery were diagnostic or therapeutic uncertainty, such as suspected residual tubo-ovarian abscess or pain. No procedure-related complications were diagnosed. CONCLUSION Transvaginal ultrasound-guided aspiration combined with antibiotics is an effective and safe treatment regimen for tubo-ovarian abscess. The high success rate indicates that it should be a first-line procedure.
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Affiliation(s)
- Knut Gjelland
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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Sudakoff GS, Lundeen SJ, Otterson MF. Transrectal and Transvaginal Sonographic Intervention of Infected Pelvic Fluid Collections. Ultrasound Q 2005; 21:175-85. [PMID: 16096614 DOI: 10.1097/01.ruq.0000174753.16708.7a] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Infected pelvic fluid collections are relatively common particularly after abdominal or pelvic surgery or in patients suffering from benign intestinal disease such as diverticulitis, appendicitis, or Crohn's disease. Historically the treatment of pelvic abscess has been either laparotomy with lavage or blind surgical incision and drainage through the rectal or vaginal wall. More recently, computed tomography and ultrasound-guided percutaneous drainage has become the procedure of choice, when feasible, for the treatment of pelvic abscess. However, many deep pelvic collections are not amenable to percutaneous technique. Transrectal or transvaginal ultrasound-guided abscess drainage is a safe and effective method used in the treatment of deep pelvic abscesses. The purpose of this article is to review the techniques, patient selection, pre- and post-procedural care, and monitoring aspects of transrectal or transvaginal ultrasound-guided drainage.
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Affiliation(s)
- Gary S Sudakoff
- Radiology and Urology, Medical College of Wisconsin, Milwaukee, USA.
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Maher MM, Gervais DA, Kalra MK, Lucey B, Sahani DV, Arellano R, Hahn PF, Mueller PR. The inaccessible or undrainable abscess: how to drain it. Radiographics 2004; 24:717-35. [PMID: 15143224 DOI: 10.1148/rg.243035100] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Percutaneous abscess drainage is a safe, effective, and widely used technique for the treatment of patients with abdominal or pelvic sepsis. The majority of abdominal and pelvic abscesses afford reasonably straightforward access and are amenable to percutaneous drainage. However, requests are occasionally received for drainage of abscesses or fluid collections that initially appear unsuitable for percutaneous drainage. Factors that render collections seemingly unsuitable for imaging-guided drainage include inaccessibility due to surrounding organs, difficult location, and thickened contents (eg, clotted blood, thick pus). Well-established alternative approaches (eg, transgluteal, transvaginal, transrectal) can be used to facilitate drainage of deep-seated collections that are inaccessible via more traditional routes. Other factors that may improve the accessibility of collections include modifications in patient positioning or in the use of imaging hardware (eg, angling of the computed tomography scanner gantry). Use of these techniques and modifications can allow percutaneous drainage of less accessible intraabdominal abscesses, thus eliminating the need for laparotomy.
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Affiliation(s)
- Michael M Maher
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, White 270, 55 Fruit St, Boston, MA 02114, USA
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18
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Abstract
The interventionist can perform many emergent procedures with ultrasound guidance, because of its real-time, multiplanar imaging capability and portability. With the use of color Doppler, additional important information, such as aberrant vessels, can be ascertained to help plan needle trajectory. Ultrasound is also useful for nonemergent procedures, such as biopsies. All interventionists are encouraged to be facile with the use of ultrasound.
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Affiliation(s)
- Dean A Nakamoto
- Department of Radiology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Abstract
The entities described in this article represent processes that arise from, or can be mistaken for, common GU infections. It might be difficult to determine the point at which pyelonephritis develops into EPN or perinephric abscess. It might be equally challenging to distinguish scrotal cellulitis from Fournier's gangrene; however, as most EPs will acknowledge, the mere awareness of these entities in the appropriate clinical circumstances might be enough to prevent a "near-miss" of a surgical emergency.
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Affiliation(s)
- Chi Lee
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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20
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Harisinghani MG, Gervais DA, Maher MM, Cho CH, Hahn PF, Varghese J, Mueller PR. Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology 2003; 228:701-5. [PMID: 12881584 DOI: 10.1148/radiol.2283020924] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the effectiveness of a computed tomographic (CT) image-guided transgluteal approach for percutaneous drainage of deep pelvic abscesses as an alternative to surgical drainage. MATERIALS AND METHODS The medical records of 140 patients who underwent percutaneous CT-guided transgluteal drainage of 154 deep pelvic abscesses were reviewed to determine the origins, location, and size of the abscesses; volume of initial aspirate; organisms identified in fluid culture; duration of catheter drainage; incidence of catheter-related pain and procedure-related complications; and short- and long-term outcomes. The resultant data were analyzed with a Fisher exact test for difference in the incidence of postprocedural catheter-site pain between transpiriformis and infrapiriformis approaches. RESULTS The origins of the pelvic abscesses included postoperative fluid collection (n = 115), perforating appendicitis (n = 6), diverticulitis (n = 16), tubo-ovarian inflammation (n = 5), Crohn disease (n = 10), and internal bowel fistula due to irradiation (n = 2). The abscesses were 4-12 cm in diameter. The volume of the aspirate was 5-310 mL. Laboratory cultures of the aspirate grew mixed flora, but the organism most frequently isolated was Escherichia coli. Catheters were removed after a mean of 8 days. In 134 (96%) of 140 patients, there was complete resolution of the abscess following transgluteal drainage, without subsequent surgery. In six of 140 (4%) patients, incomplete resolution necessitated subsequent surgery for postoperative fluid collection (n = 3), diverticulitis (n = 2), or perforating appendicitis (n = 1). Complications of transgluteal drainage were rare and included hemorrhage in three (2%) of the 140 patients. There was no procedure-related mortality. A transpiriformis approach was significantly more likely to be associated with postprocedural pain (P <.001) than was an infrapiriformis approach. CONCLUSION Percutaneous CT-guided transgluteal drainage is a safe and effective alternative to surgery for deep pelvic abscesses. Major complications are rare.
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Affiliation(s)
- Mukesh G Harisinghani
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA.
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21
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Abstract
The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that have been described to drain pelvic abscesses include transrectal or transvaginal approach with sonographic guidance, a transgluteal, paracoccygeal-infragluteal, or perineal approach through the greater sciatic foramen with CT guidance. Both the renal and the perirenal abscesses are amenable to percutaneous drainage. Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses as well.
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Affiliation(s)
- Süleyman Men
- Department of Radiology, Medical School, Dokuz Eylul University, TR-35340 Inciralti, Izmir, Turkey.
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Lee BC, McGahan JF, Bijan B. Single-step transvaginal aspiration and drainage for suspected pelvic abscesses refractory to antibiotic therapy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:731-738. [PMID: 12099560 DOI: 10.7863/jum.2002.21.7.731] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE For treatment of suspected pelvic abscesses, the use of the trocar technique avoids many of the technical challenges of the Seldinger method. The purpose of this study was to evaluate the effectiveness and safety of sonographically guided transvaginal aspiration or drainage with the trocar technique in suspected pelvic abscesses that were refractory to antibiotic treatment. METHODS We retrospectively reviewed 22 patients with suspected pelvic abscesses refractory to antibiotic therapy who underwent single-step transvaginal pelvic aspiration or drainage between 1995 and 2000. RESULTS Transvaginal aspiration or drainage was successful in 19 (86%) of the 22 patients. Of the 3 patients in whom aspiration or drainage failed, all ultimately went on to have surgery despite undergoing repeated drainage procedures. Drainage catheters were placed in 15 (68%) of the 22 patients and left in place an average of 3.7 days. Aspiration alone resulted in a 100% success rate, whereas drainage with catheter placement resulted in an 80% success rate. No complications, including bleeding, bowel perforation, and death, were reported in any of the procedures. CONCLUSIONS Transvaginal ultrasonographically guided aspiration or catheter placement with the trocar technique is a safe and effective treatment for suspected pelvic abscesses refractory to antibiotic therapy.
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Affiliation(s)
- Brett C Lee
- Department of Radiology, University of California Davis Medical Center, Sacramento 95817, USA
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