Endoscopic ultrasound guided versus surgical transrectal drainage of pelvic abscesses

Pelvic abscesses are common but only small case series reporting outcome of either endoscopic ultrasound (EUS) guided or surgical transrectal drainage have been reported.

We performed a retrospective consecutive cohort study, assessing effectivity and safety of EUS guided or surgical transrectal drainage of previously untreated pelvic abscesses from all causes, diagnosed using CT scan between 09/2010 and 06/2014 in a Dutch teaching hospital.

Forty-six patients with comparable demographics, apart from stoma presence (p = .016), were included. The success rate after a single intervention was 83% in the EUS guided compared to 48% in the surgical transrectal drainage group (p = .013). However, the mean duration of drainage was threefold in the EUS group [42 versus 13 days (p = .001)]. The length of stay in hospital was similar for both EUS and surgical group [24 versus 20 days (p = .56)] as was abscess resolution during follow-up [78% versus 74%]. We recorded a total of 12 anastomotic leaks [3 versus 9]. In the occurrence of leakage, only one stoma was finally closed in each group.

EUS guided and surgical transrectal drainage of pelvic abscesses from any cause are safe, nonetheless EUS guided drainage(if feasible) seems more effective after a single treatment, with high overall cure rates.