Percutaneous trans-bladder drainage of a pelvic abscess caused by sigmoid diverticulitis: Two case reports

Abstract

Sigmoid diverticulitis can potentially lead to the development of pelvic abscesses. Mortality rate from intra-abdominal abscesses is as high as 35%, and patients with diverticulitis complicated by an abscess are at a high risk of recurrent diverticulitis. Recently, image-guided drainage has been performed using computed tomography or ultrasonography for the treatment of pelvic abscesses. Standard radiological pelvic abscess image-guided drainage methods consist of transabdominal, transgluteal, or cranio-caudal puncture approaches. However, these standard approaches have technical limitations due to intrapelvic organ structures. Therefore, we performed image-guided drainage using a percutaneous trans-bladder approach with a simpler 1-step puncture method and a less invasive 7-Fr drainage catheter in 2 cases of a 72-year-old female and a 53-year-old female with relapsed pelvic abscesses complicated by sigmoid diverticulitis due to difficulties involving the standard approach. The abscesses in both cases disappeared on follow-up computed tomography scans, demonstrating no pelvic abscess recurrence. Our results showed that trans-bladder image-guided drainage is an effective alternative method for treating pelvic abscesses.

Keywords: Image-guided drainage; Pelvic abscess; Sigmoid diverticulitis; Trans-bladder approach.

Fig. 1

(A) The pelvic abscess (PA) (4.6 × 2.6 cm) was observed on computed tomography (CT) scan in case 1, surrounded by the bladder (b) and uterus (u). (B) A 7-Fr pigtail catheter was deployed in the PA using CT image guidance. (C) The PA decreased to 2.8 × 1.1 cm on a CT scan 7 days after the drainage. The 7-Fr pigtail catheter was removed spontaneously. (D) The PA disappeared completely 14.6 months after the drainage but a sigmoido-vesical fistula was newly recognized.

Fig. 2

(A) The pelvic abscess (PA) (5.4 × 3.4 cm) was observed on computed tomography (CT) scan in case 2, surrounded by the bladder (b) and uterus (u). (B) The PA was punctured using ultrasonography guidance via the bladder. (C) The 7-Fr pigtail catheter was deployed successfully in the PA. (D) The PA disappeared completely on the CT scan 2.7 months after the drainage.