Transvaginal Drainage of Pelvic Fluid Collections Unsuitable for Transabdominal Approach

Abstract

Purpose: To evaluate the efficacy and safety of ultrasonography- and fluoroscopy-guided transvaginal catheter drainage for pelvic fluid collection.

Materials and methods: This single-center retrospective study included nine female patients who underwent transvaginal drainage for pelvic fluid collection unsuitable for transabdominal access between October 2016 and January 2023. The study analyzed patient symptoms and signs, ultrasonography and CT findings, transvaginal approach details, and technical and clinical outcomes, including complications. Catheters of size 7 or 8.5-Fr, with or without an endocavitary needle guide were used for the puncture.

Results: Pelvic fluid collections were primarily post-operative (n = 7) or from patients with primary tubo-ovarian abscesses (n = 2). All patients achieved technical success, defined as the successful insertion of the drainage catheter at the site of target fluid collection, and clinical success, defined as the improvement of symptoms with catheter removal within 1 week. In seven cases, the procedure was assisted by an endocavitary needle guide. The median catheter indwelling period was 2 days, with two minor complications: accidental catheter removal and urinary bladder puncture, both of which were managed without further complications.

Conclusion: Ultrasonography- and fluoroscopy-guided transvaginal drainage are effective and safe methods for managing pelvic fluid collections that are unsuitable for a transabdominal approach.

Keywords: Endocavitary Needle Guide; Pelvic Fluid Collections; Transvaginal Drainage; Ultrasound.

Fig. 1. Ultrasound-guided transvaginal drainage procedure.

A, B. Transvaginal ultrasound (A) transvaginal ultrasound (B) with in-plane endocavitary needle guide. C. Once the pelvic fluid area is punctured, a 0.035-inch hydrophilic guidewire is inserted into the targeted pelvic fluid collection. D. Schematic representation of the transvaginal catheter insertion into the pelvic cavity.

Fig. 2. A 42-year-old female (patient no. 3) with abdominal pain, fever, and vaginal discharge 2 weeks post-open uterine myomectomy.

A. Contrast-enhanced CT coronal reconstructed image shows about 9 cm sized loculated fluid collection with air-bubble and enhancing wall in a cul-de-sac. B, C. Transvaginal ultrasound with adaptor guidance (B), fluoroscopy image of transvaginal catheter insertion (C). D. On the 5th day of the indwelling transvaginal catheter, follow-up transabdominal ultrasonography shows a markedly decreased fluid collection (maximal diameter = 3.77 cm), and the catheter was removed.

Fig. 3. A 59-year-old female (patient no. 9) with a right tubo-ovarian abscess.

A-D. Contrast-enhanced CT axial image (A) and coronal reconstructed image (B) show multi-septated complicated fluid collection with rim enhancement at the right ovary. Transvaginal ultrasound with adaptor guidance (C) and fluoroscopy image of transvaginal catheter insertion with an endocavitary needle guide (D) are shown.