Deep pelvic abscesses: transrectal drainage with radiologic guidance

Transrectal catheter drainage was performed under radiologic guidance in eight patients with deep pelvic abscesses during a 7-month period. One patient underwent two procedures. In five patients, the abscess could not be palpated at rectal examination. Seven procedures were performed with fluoroscopic guidance. Transrectal ultrasound was performed in conjunction with fluoroscopy for two procedures. Medium to large (8-14-F) locking catheters were used in seven procedures, and small (5-F) nonlocking pigtail catheters were used in two. The catheter was left in place for 3 days or less in all but one patient, in whom the catheter was left in place for 20 days. Five abscesses were drained through the anterior or anterolateral rectal wall and four, including one repeat drainage, through the posterior rectal wall. No complications occurred as a direct result of transrectal drainage. Successful initial drainage was established with clinical improvement in all cases. Two patients eventually required surgery, one for continued bleeding into an infected hematoma and one for abscess recurrence after tube dislodgment. Transrectal drainage performed with radiologic guidance is a safe, feasible procedure; is well tolerated by patients; and is relatively easy to perform with the techniques described.