CT-guided Transgluteal Drainage of Deep Pelvic Abscesses: Indications, Technique, Procedure-related Complications, and Clinical Outcome

Abstract

Deep pelvic abscesses may present a unique challenge for percutaneous drainage because of numerous overlying structures, which preclude safe percutaneous access. These structures include the pelvic bones, intestine, bladder, iliac vessels, and gynecologic organs. Use of the transgluteal approach to drain these abscesses can circumvent these obstacles and provide a useful surgical alternative or a temporizing measure. The transgluteal approach requires a thorough understanding of the anatomy of the sciatic foramen region and associated anatomic structures. The ideal approach for transgluteal access is to insert the catheter as close to the sacrum as possible, at the level of the sacrospinous ligament. Transgluteal drainage can be performed with the tandem-trocar technique or the Seldinger technique. Modifications of the procedure are needle aspiration not followed by catheter placement, use of the angled gantry technique, bilateral transgluteal drainage, combined anterior and posterior drainage, and drainage of necrotic pelvic masses. The transgluteal approach is a useful option in pediatric patients. Daily catheter care is essential for successful percutaneous catheter therapy. Although pain has been cited as a common complication of the technique, this complication can be minimized with judicious use of analgesia and a meticulous technique. Other complications are hemorrhage and catheter malposition.

Impact of Surgical Infection Society/Infectious Disease Society of America-recommended antibiotics on postoperative intra-abdominal abscess with image-guided percutaneous abscess drainage following gastrointestinal surgery

“…Advances in image-guided percutaneous abscess drainage (PAD) have recently provided a safe and effective alternative to surgical drainage [4,[6][7][8][9]. PAD has become a widely accepted treatment for accessible postoperative abscesses [9][10][11][12][13].…”

Large Gluteal Abscesses as a Complication of Transgluteal Drainage of Pelvic Abscesses: Analysis of Three Cases and a Search of the Literature

“…Also, Gazelle et al[ 4] mention tracking of the abscess. However, the few evaluations on transgluteal drainage that have been reported in the literature do not describe a case in which drainage is complicated by the development of a gluteal abscess [2, 6, 7]. The only major complication described was hemorrhage [2].…”

“…Radiological transrectal approaches have been described using CT- [4] and sonographic guidance [5]. Although not affecting the outcome, the only drawbacks described are the dislodgement and expulsion of the catheter [5, 6, 8]. However, the absence of any complications was described frequently, and transrectal drainage is described as the preferred method of drainage of deep pelvic abscesses [4, 5, 9, 10].…”

“…Pelvic abscesses may occur as a complication of a contained anastomotic leak after colon resection [6]. Until now, these abscesses have frequently been drained transgluteally (CT- or sonographically guided).…”

Ileal Pouch–Anal Anastomosis Surgery: Imaging and Intervention for Post-operative Complications

“…Management of an abscess often includes ultrasonography (US)-or CT-guided drainage and treatment with antibiotics. Deep abscesses are more accessible by way of a transgluteal approach, which requires that the patient be in the prone position (10). At our institution, we often use the Seldinger technique to reduce the risks for hemorrhage and injury to adjacent structures.…”