Abstract:

Aim: was to evaluate the feasibility and effectiveness of using transperineal access for sanitation of «deep» exudative pelvic lesions in patients after gynecological operations.

Materials and methods: results of percutaneous drainage with perineal access of «deep» – perirectal postoperative exudative pelvic lesions in 18 patients after extirpation of the uterus in oncological pathology were subjected to retrospective analysis. Exudative formations in the pelvis were detected during continuous postoperative ultrasound screening of operated patients starting from 3rd day of the postoperative period, taking into account clinical data.

Perineal access was used in patients with verification of the nature of the pathological contents and subsequent drainage of the pathological exudation zone by 8fr drains with form memory using Seldinger method.

Results: manipulation was successful in all 18 patients. In 5 cases, a lyzed pelvic hematoma was drained, and in 13 cases, an abscess was drained. In three cases, the connection of the abscess cavity with the lumen of the rectum was revealed. There were no complications due to manipulation. The drainage period was 6-7 days for hematoma and 10-16 days for abscess without internal fistula. If there is a connection with the lumen of the rectum, the drainage period was 21 days, the drainage was removed with x-ray confirmed closure of the internal fistula.

Conclusion: our first positive experience of using transperineal access for the rehabilitation of intrapelvic exudative complications of the postoperative period in oncogynecological patients inspires cautious optimism, expands the arsenal of mini-invasive methods of treatment of intra-pelvic postoperative exudative complications, but undoubtedly requires further research for optimal integration of the technique into the practice of oncogynecology and x-ray surgery departments.

References

1.     Lorenz JM, Al-Refaie WB, Cash BD, et al. ACR appropriateness criteria radiologic management of infected fluid collections. J Am Coll Radiol 2015; 12: 791–799.

2.     Hynes D, Aghajafari P, Janne d'Othee B. Role of Interventional Radiology in the Management of Infection. Semin Ultrasound CT MR. 2020 Feb; 41(1):20-32.

3.     Kadrev AV. Punctures under the control of echography in the diagnosis and treatment of pelvic fluid in women. Cand. of med. sci. diss. Мoscow. 2007: 159 [In Russ].

4.     Albuquerque A, Pereira E. Current applications of transperineal ultrasound in gastroenterology. World J Radiol. 2016; 8(4): 370-377.

5.     Sperling DC, Needleman L, Eschelman DJ, Hovsepian DM, Lev-Toaff AS. Deep pelvic abscesses: transperineal US-guided drainage. Radiology. 1998; 208(1):111-5.

6.     Golferi R, Cappelli A. Computed tomography-guided percutaneous abscess drainage in coloproctology: review of the literature. Tech Coloproctol. 2007; 11: 197–208.

7.     Khurrum Baig M, Hua Zhao R, Batista O, et al. Percutaneous postoperative intra-abdominal abscess drainage after elective colorectal surgery. Tech Coloproctol. 2002; 6: 159–164.

8.     De Kok BM, Marinelli A.W.K.S., Puylaert J.B.C.M., et. al. Image-guided posterior transperineal drainage for presacral abscess: An analysis of 21 patients. Diagn Interv Imaging. 2019; 100(2): 77-83.