Endoscopic ultrasound-guided drainage of pelvic abscess without fluoroscopy guidance

Abstract

Background and aims: Few case series are reported on endoscopic ultrasound (EUS)-guided drainage of pelvic abscesses under fluoroscopy guidance. We hypothesized that EUS-guided drainage of pelvic abscesses without fluoroscopy is an effective alternative to surgery in patients whose abscesses are not amenable to percutaneous drainage techniques. The aim of this study is to evaluate the clinical efficacy of EUS-guided trans-rectal/transcolonic drainage of pelvic abscess without fluoroscopy.

Methods: Fourteen consecutive patients with pelvic abscesses not amenable to percutaneous drainage underwent EUS-guided drainage over a period of 22 months. Main outcome measures were the resolution of the pelvic abscess on repeat imaging and improved clinical symptoms.

Results: Fourteen consecutive patients were enrolled. EUS-guided aspiration was performed in three patients. In two patients, dilatation and aspiration was performed, while trans-rectal stent was placed in nine patients. All patients became afebrile within 72 h. Stent was removed in all patients, after confirming the resolution of the abscess on repeat computed tomography after 7 days. One patient in whom only aspiration was done had recurrence of fever and abscess on the seventh day and was treated by surgical drainage. A follow-up EUS done in 13 of the patients after 3 months revealed no recurrence, and all patients were asymptomatic at 6 months. The procedure was uneventful in all patients.

Conclusion: Endoscopic ultrasound-guided drainage without fluoroscopy is a safe and effective modality of treatment for pelvic abscesses not amenable to radiologically guided drainage, thus reducing the need for surgical intervention.