TREATMENT OF PELVIC ABSCESSES - VALUE OF ONE-STEP SONOGRAPHICALLY GUIDED TRANSRECTAL NEEDLE ASPIRATION AND LAVAGE

OBJECTIVE. The percutaneous treatment of pelvic abscesses has traditio nally involved the placement of drainage catheters via a transgluteal, transrectal, or transvaginal route. These procedures are painful and prolonged. The goal of this study was to demonstrate the effectiveness of a one step, single-puncture method for draining pelvic abscesses b y use of a transrectal sonographically guided needle for aspiration an d ravage instead of a two-step Seldinger technique for catheter placem ent. SUBJECTS AND METHODS. Thirty-three pelvic abscesses in 24 patient s were drained by use of transrectal ultrasound guidance. All abscesse s were initially seen on transrectal sonograms or CT scans and ranged from 2 to 11 cm in diameter. Abscesses were located in the prostate (n = five), seminal vesicles (n = five), pouch of Douglas (n = 21), and interloop (between bowel loops) (n = two). Causes of pouch of Douglas (cul-de-sac) abscesses included appendicitis (n = two), Crohn's diseas e (n = two), diverticulitis (n = three), trauma (n = six), HIV infecti on (n = two), complications of sigmoidectomy (n = one), complications of colectomy (n = one), pelvic inflammatory disease (n = two), and sev ere prostatitis (n = two). Interloop abscesses were attributable to HI V infection (n = one) and lymphoma (n = one). The procedure was perfor med without a cleansing enema or local anesthesia and required less th an 30 min. An 18-gauge needle was inserted transrectally into the absc ess cavity under transrectally guided sonography. The fluid collection was completely aspirated, and the cavity was lavaged with saline. Adm inistration of antibiotics for 7-21 days, rather than prolonged cathet er drainage, was used to treat residual infection. Resolution was docu mented after 7 days by sonography or CT examination. RESULTS. Transrec tal aspiration was successful in treating 28 (85%) of the 33 pelvic ab scesses in 21 (88%) of the 24 patients. Failure occurred in three pati ents, two with multiple abscesses and one with an enteric fistula for whom surgical drainage was subsequently required. The volume of aspira tes ranged from 5 to 220 ml. There were no complications. CONCLUSION. Transrectal sonographically guided needle aspiration-lavage offers a o ne-step method for treating pelvic abscesses that does not require cat heter placement or prolonged drainage. The procedure produces minimal discomfort and essentially no complications. Our results show that tra nsrectal sonographically guided needle aspiration combined with antibi otic therapy is an effective treatment for pelvic abscesses.