PELVIC ABSCESS AFTER COLON AND RECTAL SURGERY - WHAT IS OPTIMAL MANAGEMENT

PURPOSE: The aim of this study was to compare treatment outcomes in th e management of pelvic abscess (PA) after rectal surgery. METHODS: Ove r a 12-year period all PAs occurring in the patients undergoing colore ctal resection were retrospectively reviewed. The APACHE II Score was used to stratify illness. RESULTS: Postoperative PA developed in 56 pa tients after cancer (32 percent), ulcerative colitis (26 percent), div erticular disease (24 percent), and Crohn's colitis (18 percent)/surge ry. Overall, 24 (43 percent) of PAs were after operations for inflamma tory bowel disease and 43(77 percent) of PAs were after intrapelvic in testinal anastomoses. PAs were treated by 1) antibiotics alone (11/56) , 2) percutaneous computerized tomography-guided catheter drainage (13 /56), 3) transperineal drainage (15/56), or 4) laparotomy (17/56). Rec urrent PAs developed in 11/56 (19 percent) after initial treatment, of which 7 required additional surgery. These recurrences were evenly di stributed between treatment groups. There were three deaths as a resul t of PA, two after laparotomy and one after percutaneous drainage. Lon g-term sequela in patients with intestinal anastomosis included loss o f intestinal continuity (10/43) and anastomotic stenosis (7/43). There was no difference in APACHE II Score among the four treatment groups. The mortality rate was 75 percent among patients whose APACHE II Scor es were greater than 1 5. The development of a PA after colon and rect al surgery was associated with a 5 percent mortality and 4 1 percent f unctional morbidity (23 percent permanent stoma and 18 percent symptom atic stricture rate). CONCLUSION: Using clinical judgment, if PA is am enable to computerized tomography-guided percutaneous or transperineal drainage, one of these techniques should be attempted initially in th e hemodynamically stable nonseptic patient. Long-term functional disab ility is common after PA in rectosigmoid surgery in patients who under go pelvic/intestinal anastomosis.