TREATMENT OF PELVIC ABSCESSES AND OTHER FLUID COLLECTIONS - EFFICACY OF TRANSVAGINAL SONOGRAPHICALLY GUIDED ASPIRATION AND DRAINAGE

OBJECTIVE. The purpose of this study was to evaluate the clinical effi cacy of transvaginal sonographically guided aspiration and drainage of pelvic fluid collections. MATERIALS AND METHODS. Forty patients under went transvaginal sonographically guided aspiration of a possible pelv ic abscess (41 pelvic collections). In patients with clinical findings highly suggestive of infection, both purulent and nonpurulent collect ions were immediately drained via a catheter. In patients with clinica l findings moderately suggestive of infection, nonpurulent collections were completely removed by aspiration and the aspirates were cultured ; however, purulent collections were immediately drained via a cathete r. RESULTS. All collections were successfully accessed by transvaginal sonography. For 27 of the 41 collections, the aspirate was purulent ( 18 collections) or the patient's clinical findings were highly suggest ive of infection (nine collections) and catheter drainage was performe d. Seventeen of the 27 collections completely resolved and surgery was not required. Four of the 27 collections were in patients who had sur gery for reasons other than persistent infected collection. For six of the 27 collections, catheter treatment was not successful and surgery was required. The overall success rate of catheter drainage was 78%. In the remaining 14 of the 41 collections, the aspirate was serous or serosanguineous, and the patient's clinical findings were moderately s uggestive of infection. Cultures of aspirates of seven collections wer e positive for microorganisms. Eleven collections were successfully tr eated with antibiotics or no therapy was required (based on culture re sults); for three, surgery was required. Two complications occurred: o ne vaginal fistula after catheter drainage and one disruption of vagin al sutures after aspiration. CONCLUSION. Transvaginal sonographically guided drainage is effective treatment of pelvic abscess, being either completely curative or temporizing in 78% of patients. Catheter treat ment was unsuccessful and surgery was necessary in 22% of patients. Fo r nonpurulent collections, catheter drainage is indicated only when cl inical findings are highly suggestive of infection.