Ultrasound guided transrectal catheter drainage of pelvic collections

Abstract

Percutaneous catheter drainage (PCD) is the standard of care in the management of intra-abdominal collections where immediate surgery is not indicated. 1 Pelvic collections are challenging for a trans-abdominal approach to drainage. 2 Alternative approaches (trans-rectal, trans-vaginal and transgluteal) can be used to circumvent risks associated with transabdominal drainage in such cases. Among these, the transrectal route is less painful, better tolerated and with proper technique, high clinical cure rates can be attained with fewer complications. 3 In this article we discuss 6 cases with pelvic collections, treated with trans-rectal drainage, and thereby highlight issues pertaining to this method of treatment. Technique of transrectal drainage A review of pre-procedure imaging including transabdominal ultrasound and CECT abdomen was performed. Only patients found unsuitable for safe transabdominal drainage were Short Reports evaluated further for the transrectal approach. The patient's coagulation profile (prothrombin time, activated partial thromboplastin time, international normalized ratio and platelet count) was reviewed. Those with deranged coagulation profile (INR >1.5 &/or platelet count < 50,000/mm 3) were taken up for procedure following correction of coagulation status. All patients received broad spectrum intravenous antibiotics and rectal enema prior to procedure. Informed consent was taken. An 8-4 MHz end-fire probe (3D9-3v, HD 11 XE, Philips) covered with a condom and with a biopsy guide attached was used for transrectal sonographic guidance with patient in left lateral decubitus position. The collection was localized and 18G Chiba needle (Cook Inc., Bloomington, USA) was advanced after administration of 10ml of local anesthetic (Inj. Lignocaine 2%). Samples for culture were obtained. A 0.9 mm (0.035 in.) amplatz ultra-stiff guidewire (Cook Inc., Bloomington, USA) was inserted through the needle and coiled within the abscess cavity. After serial dilatations with a Coons dilator, a self

ACR Appropriateness Criteria® Radiologic Management of Infected Fluid Collections

“…Depending on location, pelvic fluid collections can be drained via the transabdominal, transgluteal, transrectal, transvaginal, transperineal, and transvesicular routes. The efficacy and safety of these routes have been established by a number of retrospective reports [88][89][90][91][92][93][94]. The choice of route for a given abscess varies among operators and institution type, with transrectal and transvaginal approaches used much more commonly in academic centers [95].…”