Ultrasound Guided Trans-Gluteal Approach for Percutaneous Collection Drainage: Why, Who and How?

Background: Percutaneous abscess drainage is the standard of care in the absence of indications for immediate surgery. Variety of disorders can produce fluid collections in the lower abdomen and pelvis. These pelvic collections can be drained in several approaches with the trans-gluteal approach being useful and effective. Advantage of the ultrasonographic approach include less time in the CT-imaging area, less procedural time, less radiation exposure, and ability to avoid blood vessel puncture by real-time color Doppler during catheter placement. Disadvantages include poor sonographic penetration in the deep pelvic tissues of even an average-sized adult. Method(s): We elected to overcome the necessity of CT-guidance for drainage of pelvic collections by using trans-gluteal sonographic guidance. Curved-3-5 MHz transducer is used to scan the pelvis with the patient in prone position from para-sacral regions. The coccyx was palpated as a landmark, and the puncture site should be caudal and close to this landmark to avoid damage to the neuro-vascular bundle. Oblique-sagittal or axial imaging through the area of the greater sciatic foramen is used to guide the needle into the collection. Drainage can be performed by using the Seldinger or trocar technique under local and conscious sedation. The catheter removed once the output diminished to <20 ml/day for 48-72 hours. Result(s): We elected to overcome the necessity of CT-guidance for drainage of pelvic collections by using trans-gluteal sonographic guidance. Curved-3-5 MHz transducer is used to scan the pelvis with the patient in prone position from para-sacral regions. The coccyx was palpated as a landmark, and the puncture site should be caudal and close to this landmark to avoid damage to the neuro-vascular bundle. Oblique-sagittal or axial imaging through the area of the greater sciatic foramen is used to guide the needle into the collection. Drainage can be performed by using the Seldinger or trocar technique under local and conscious sedation. The catheter removed once the output diminished to <20 ml/day for 48-72 hours. Conclusion(s): Ultrasonographic-guided trans-gluteal abscess drainage is an alternative route for pelvic collections. This procedure is safe and effective for moderate/large fluid collections in non-obese patients and eliminates the need for using valuable CT time to perform these procedures.

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Artikel online veröffentlicht:
11. Mai 2021