Download PDF
CC BY 4.0 · Surg J (N Y) 2023; 09(04): e145-e148
DOI: 10.1055/s-0043-1777791
Case Report

Endoscopic Ultrasound-Guided Transrectal Pelvic Abscess Drainage (EUS-PAD) – Bridging to Surgery: Report of Two Cases

Tina Goerl
1   Klinik Für Allgemein- und Viszeralchirurgie, Bodden-kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
,
Christoph Speck
2   Klinik Für Innere Medizin II/Gastroenterologie, Bodden-kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
,
Alexander Gehring
1   Klinik Für Allgemein- und Viszeralchirurgie, Bodden-kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
,
Reiko Wiessner 
1   Klinik Für Allgemein- und Viszeralchirurgie, Bodden-kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background Currently, the methods for drainage of pelvic abscess primarily use computed tomography- or ultrasound-guided percutaneous drainage or surgical drainage. Endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) is an alternative, minimally invasive tool to drain an abscess, localized close to the rectum or left colon, and therefore not accessible by other means.

Methods We report on the success of endoscopic ultrasound-guided drainage of peridiverticulitic abscess based on the two cases presented here. Using endoscopic ultrasound guidance an aspiration of the abscess from the endoluminal could be realized. After successive balloon dilatation via a guidewire while using X-ray imaging, the placement of pigtail or flap stent was performed. In addition, conservative therapy measures such as antibiotics, diet, and pain management were performed.

Results The interventions were successful in both patients, resulting in rapid recourse of discomfort, abscess size, and sepsis. After controlling the consequences of complicated diverticulitis, both patients underwent laparoscopic sigmoid resection with primary anastomosis and without ileostomy during an inflammation-free interval.

Conclusion Both cases demonstrate the advantages of EUS-PAD. A laparoscopic operation with primary anastomosis, lower perioperative risk, and without need of a protective ileostomy in early elective setting became possible by bridging the time until surgery by using EUS-PAD.

Keywords

endoscopic ultrasound - pelvic abscess drainage - transrectal surgery - bridging to surgery

Authors’ Contributions

Conceptualization R.W. and C.S., methodology R.W., C.S., and A.G., formal analysis A.G. and T.G., investigation R.W. and C.S., writing—original draft preparation T.G., writing—review and editing T.G. and R.W., visualization T.G., A.G., and R.W.




Publication History

Received: 18 August 2023

Accepted: 20 November 2023

Article published online:
19 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 S3-Leitlinie Divertikelkrankheit/Divertikulitis – Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie. Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). November 2021–AWMF-Registernummer: 021–20
    PubMed
  • 2 Durmishi Y, Gervaz P, Brandt D. et al. Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan. Surg Endosc 2006; 20 (07) 1129-1133
    CrossrefPubMedGoogle Scholar
  • 3 Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978; 12: 85-109
    PubMedGoogle Scholar
  • 4 Jaffe TA, Nelson RC. Image-guided percutaneous drainage: a review. Abdom Radiol (NY) 2016; 41 (04) 629-636
    CrossrefPubMedGoogle Scholar
  • 5 Azzarello G, Lanteri R, Rapisarda C. et al. Ultrasound-guided percutaneous treatment of abdominal collections. Chir Ital 2009; 61 (03) 337-340
    PubMedGoogle Scholar
  • 6 Giovannini M, Bories E, Moutardier V. et al. Drainage of deep pelvic abscesses using therapeutic echo endoscopy. Endoscopy 2003; 35 (06) 511-514
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Dhindsa BS, Naga Y, Saghir SM. et al. EUS-guided pelvic drainage: a systematic review and meta-analysis. Endosc Ultrasound 2021; 10 (03) 185-190
    CrossrefPubMedGoogle Scholar
  • 8 Liu S, Tian Z, Jiang Y, Mao T, Ding X, Jing X. Endoscopic ultrasound-guided drainage to abdominal abscess: A systematic review and meta-analysis. J Minim Access Surg 2022; 18 (04) 489-496
    CrossrefPubMedGoogle Scholar
  • 9 Donatelli G, Cereatti F, Fazi M, Ceci V, Dhumane P. Endoscopic ultrasound-guided drainage of intra-abdominal diverticular abscess. A case series. J Minim Access Surg 2021; 17 (04) 513-518
    CrossrefPubMedGoogle Scholar