Endoscopic Ultrasound-Guided Transrectal Pelvic Abscess Drainage (EUS-PAD) - Bridging to Surgery: Report of Two Cases

Background  Currently, the methods for drainage of pelvic abscess primarily use computed tomography- or ultrasound-guided percutaneous drainage or surgical drainage. Endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) is an alternative, minimally invasive tool to drain an abscess, localized close to the rectum or left colon, and therefore not accessible by other means. Methods  We report on the success of endoscopic ultrasound-guided drainage of peridiverticulitic abscess based on the two cases presented here. Using endoscopic ultrasound guidance an aspiration of the abscess from the endoluminal could be realized. After successive balloon dilatation via a guidewire while using X-ray imaging, the placement of pigtail or flap stent was performed. In addition, conservative therapy measures such as antibiotics, diet, and pain management were performed. Results  The interventions were successful in both patients, resulting in rapid recourse of discomfort, abscess size, and sepsis. After controlling the consequences of complicated diverticulitis, both patients underwent laparoscopic sigmoid resection with primary anastomosis and without ileostomy during an inflammation-free interval. Conclusion  Both cases demonstrate the advantages of EUS-PAD. A laparoscopic operation with primary anastomosis, lower perioperative risk, and without need of a protective ileostomy in early elective setting became possible by bridging the time until surgery by using EUS-PAD.