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EUS-guided drainage of pelvic abscess (with video)

  • Shyam Varadarajulu
    Correspondence
    Reprint requests: Shyam Varadarajulu, MD, Division of Gastroenterology-Hepatology, University of Alabama at Birmingham Medical Center, 410 LHRB, 1530 3rd Ave S, Birmingham, AL 35294.
    Affiliations
    Current affiliations: Division of Gastroenterology-Hepatology (S.V.), Division of Gastrointestinal Surgery (E.R.D.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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  • Ernesto R. Drelichman
    Affiliations
    Current affiliations: Division of Gastroenterology-Hepatology (S.V.), Division of Gastrointestinal Surgery (E.R.D.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
    Search for articles by this author

      Background

      Although pelvic abscesses have traditionally been drained by surgery or under radiologic guidance, a small subset of patients who are not candidates for these interventions require an alternate mode of drainage.

      Objective

      Evaluate the efficacy of EUS for drainage of pelvic abscesses that could not be drained under US or CT guidance.

      Design

      Prospective case series.

      Setting

      Tertiary referral center.

      Patients

      Four patients underwent EUS-guided drainage of pelvic abscesses that were not amenable for drainage by US and/or CT guidance.

      Interventions

      A 10F drainage catheter was deployed in the abscess cavity under EUS guidance in all patients. The catheters were flushed periodically until resolution of the abscess was confirmed by CT imaging.

      Main Outcome Measurements

      Resolution of a pelvic abscess on follow-up CT and improvement in clinical symptoms.

      Results

      A drainage catheter was successfully placed in all 4 patients. The mean size of the abscess was 68 × 72 mm. There were no procedure-related complications. One patient died of worsening congestive heart failure 48 hours after the procedure. The abscesses resolved in the remaining 3 patients within a mean duration of 6 days, with complete symptom relief.

      Limitations

      A small number of patients and short duration of follow-up.

      Conclusions

      EUS-guided placement of drainage catheter is a minimally invasive technique for draining pelvic abscesses that are within the reach of the echoendoscope.
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