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Transrectal Drainage of Deep Pelvic Abscesses Using a Combined Transrectal Sonographic and Fluoroscopic Guidance |
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Kyung Soon Jeong, M.D Gyoo Sik Jung, M.D.*, Eun Jung Lee, M.D., Ji Ho Ko, M.D., Young Duk Joh, M.D. |
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Department of Diagnostic Radiology, Gospel Hospital, College of Medicine, Kosin University *Department of Diagnostic Radiology, Ulsan Hospital |
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PURPOSE : To evaluate the feasibility and clinical efficacy of transrectal drainage of a deep pelvic abscess using
combined transrectal sonographic and fluoroscopic guidance.
MATERIALS and METHODS : From March 1995 and August 2004, 17 patients (9 men; 8 women; mean age, 39years)
suffering from pelvic pain, fever and leukocytosis were enrolled in this retrospective study. Ultrasound (US) or
computed tomography (CT), which was obtained prior to the procedure, showed pelvic fluid collections that
were deemed unapproachable by the percutaneous transabdominal routes. Transrectal drainage of the pelvic abscess
was performed under combined transrectal sonographic and fluoroscopic guidance. The causes of the
deep pelvic abscess were postoperative complications (n=7), complications associated with radiation (n=3) and
chemotherapy (n=1) as well as unknown causes (n=6). A 7.5-MHz end-firing transrectal US probe with a needle
biopsy guide attachment was advanced into the rectum. Once the abscess was identified, a needle was advanced
via the biopsy guide and the abscess was punctured. Under US guidance, either a 0.018"or 0.035"
guidewire was passed through the needle in the abscess. Under fluoroscopic guidance, the tract was dilated to
the appropriate diameter with sequential fascial dilators, and a catheter was placed over the guide wire within the
abscess. Clinical success of drainage was determined by a combination closure of the cavity on the follow up
images and diminished leukocytosis. The technical and clinical success rate, complications, and patient’s discomfort
were analyzed.
RESULTS : Drainage was technically successful in all patients and there were no serious complications. Surgery was
eventually performed in two cases due to fistular formation with the rectum and leakage of the anastomosis site.
The procedure was well tolerated in all but one patient who complained of discomfort while the catheter was inserted
. The catheter did not interfere with defecation and there was no incidence of catheter expulsion by defecation.
CONCLUSION : Transrectal drainage of deep pelvic abscesses using ultrasound and fluoroscopic guidance is a safe,
feasible procedure that is well tolerated by patients and is relatively easy to perform. |
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Keyword : Abscess Pelvis Ultrasound (US), guidance Ultrasound (US), therapeutic |
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pdf파일 : 111-118정경순.pdf
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