CT-guided paracoccygeal drainage of pelvic abscesses

Using the transrectal/transvaginal routes for the drainage of pelvic abscesses complicating colorectal surgery (anterior resection or abdominoperineal resection) is not always possible. The conventional transgluteal approach through the greater sciatic foramen, although proven to be a valuable access route, can have complications (mainly local pain).

To avoid these difficulties, a CT-guided paracoccygeal-infragluteal approach was used in the percutaneous drainage of deep pelvic (presacral and ischiorectal) abscesses presenting after colorectal surgery in six patients.

Percutaneous drainage through this approach was successful in preventing the need for surgery in all six patients. No complications or recurrences were noted, and catheters were removed an average of 15 days after insertion.

In comparison with the classical transgluteal approach, the paracoccygeal-infragluteal approach minimizes patient discomfort and minimizes the risk of potential injury to the sciatic plexus or blood vessels. This initial series shows that a CT-guided paracoccygeal-infragluteal approach is well tolerated, safe, and effective for the percutaneous drainage of pelvic abscesses developing after colorectal surgery.