Percutaneous cholecystostomy tube placement for acute cholecystitis in the extreme elderly

Abstract

Learning Objectives: This exhibit will present a review of transrectal and transvaginal approaches to pelvic collection drainage. Pre-procedure and intra-procedure imaging will be reviewed, with focus on anatomic landmarks and potential pitfalls. Technical aspects and clinical outcomes will be reviewed. Case-based illustrative examples will be provided from our institutional experience. Background: Deep pelvic fluid collections are common complications of infectious, inflammatory, and post-surgical abdominal pathology. They pose unique clinical challenges when transabdominal or transgluteal drainage is not feasible. Transrectal and transvaginal approaches are uniquely suited to avoid overlying gastrointestinal, vascular and bony structures. However, the genitourinary organs are infrequently imaged by the interventional radiologist and may misrepresent true pathology. An understanding of the anatomic relationships and ultrasound appearance of pelvic structures is helpful in avoiding potential complications. Clinical Findings/Procedure Details: Examples from our institutional experience will demonstrate collections within potential spaces in the deep pelvis as seen on cross-sectional imaging and endocavitary ultrasound correlated to pictorial representations. Nearby structures that may mimic pathology will be depicted. Clinical outcomes from our institutional experience will be reviewed, including duration of drainage, frequency of re-intervention, and rates of dislodgement, occlusion, and other complications. Conclusions: Deep fluid collections within the pelvis pose unique clinical and technical challenges, which may be overcome with transrectal or transvaginal drainage. Ultrasound-guided drain placement is aided with a thorough knowledge of anatomic relationships within the pelvis and their appearance on endocavitary sonography.