EUS-guided transrectal drainage of pelvic fluid collections using electrocautery-enhanced lumen-apposing metal stents: a case series

Abstract

Background and Aims Pelvic fluid collections (PFCs) are frequent adverse events of abdominal surgery or inflammatory conditions. A percutaneous approach to deep PFCs could be challenging and result in a longer, painful recovery. The transvaginal approach has been considered easy but is limited by the difficulty of leaving a stent in place. The transrectal approach has been described, but issues related to fecal contamination were hypothesized. Data on EUS-guided transrectal drainage (EUS-TRD) with lumen-apposing metal stents (LAMSs) are few and suggest unsatisfactory outcomes. The aim of this study was to evaluate the safety and efficacy of EUS-TRD with LAMSs in patients with PFCs. Methods A retrospective analysis of a prospectively maintained database on therapeutic EUS was conducted. All EUS-TRD procedures were included. Results Five patients (2 male, age 44-89 years) were included. Four patients had postoperative PFCs, and 1 presented with a pelvic abscess complicating acute diverticulitis. Two of 5 had fecal diversion; the remaining 3 had unaltered large-bowel anatomy. One case had a concomitant abdominal collection, treated with percutaneous drainage in the same session. An electrocautery-enhanced LAMS delivery system (15 × 10 mm) was used in all cases. EUS-TRD was performed with the direct-puncture technique and lasted less than 10 minutes in 4 cases; in the remaining case, needle puncture and LAMS placement over a guidewire was required, and the procedure length was 14 minutes. The clinical success rate was 100%. LAMSs were removed after a median of 14 (range, 12-24) days. One patient reported partial proximal LAMS migration after 24 days (mild adverse event). No PFC recurrence was observed. Conclusion EUS-TRD with LAMSs is a safe and effective technique for treatment of PFCs. The use of 15- × 10-mm LAMSs allows rapid PFC resolution. EUS-TRD could be performed not only in patients with fecal diversion but also in cases of unaltered anatomy.

Endoscopic Ultrasound-Guided Transrectal Drainage of Perirectal Abscess in a Patient with Crohn Disease

“…A retrospective analysis was conducted of EUS-guided transrectal drainage of pelvic fluid collections (PFC) using LAMS [ 12 ]. The study included 5 patients; 4 had postoperative PFC while 1 had an abscess that arose as a complication of acute diverticulitis.…”

Pelvic Fluid Collection Post Vaginal Delivery Treated with Ultrasonic Aspiration: A Case Report

“…Interestingly, only one patient was evident prior to the sonography. In addition, the laboratory test particularly the white cell count, ESR, and CRP (inflammatory markers) are extremely helpful in both diagnosis and treatment response [5,17]. Here, the combination of the clinical presentation of elevated white cell count and inflammatory markers along with the presence of pelvic fluid collections in imaging was highly suggestive of the diagnosis.…”

“…Here, the combination of the clinical presentation of elevated white cell count and inflammatory markers along with the presence of pelvic fluid collections in imaging was highly suggestive of the diagnosis. Antibiotics are usually the preferred first-line therapy but, medical therapy is usually insufficient in the majority of cases [5,15]. Drainage of the pelvic fluid is a gold standard technique and usually leads to favorable outcomes.…”

“…It usually occurs following abdominal surgeries, genitourinary surgeries, inflammatory conditions such as appendicitis, Crohn's disease, diverticulitis, and complicated hysterectomy [2,3,4]. PFC is basically a wall of thick fibrous tissue that delineate an area of pus and necrotic tissues [5]. In pregnancy Young age group, prolonged labor, premature rupture of membrane and cephalopelvic disproportion are the major risk factors [6].…”

Recent Endoscopic Ultrasound-Related Publications With Potential to Influence Clinical Practice

“…Similar findings have been seen for other conditions such as infected walled-off pancreatic necrosis and postsurgical collections. 11 12 EUS-GBD also permits removal of stones from the gallbladder ( Fig. 3 ).…”