ABSTRACT
BACKGROUND: Pelvic abscesses are common but only small case series reporting outcome of either endoscopic ultrasound (EUS) guided or surgical transrectal drainage have been reported. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Subject(s)
Abscess/surgery , Drainage/methods , Endosonography/methods , Pelvic Infection/surgery , Surgery, Computer-Assisted/methods , Abscess/diagnostic imaging , Adult , Aged , Cohort Studies , Databases, Factual , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Female , Follow-Up Studies , Hospitals, Teaching , Humans , Male , Middle Aged , Netherlands , Patient Safety/statistics & numerical data , Pelvic Infection/diagnostic imaging , Rectum/surgery , Retrospective Studies , Risk Assessment , Severity of Illness Index , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Laparoscopy/methods , Rectal Prolapse/surgery , Rectum/surgery , Reoperation/methods , Adult , Aged, 80 and over , Female , Humans , Middle Aged , Recurrence , Treatment OutcomeABSTRACT
BACKGROUND: Rigid proctosigmoidoscopy is recommended for measuring the height of rectal neoplasms but appears to be performed in only a minority of patients. Our aim was to compare endoscopic and radiological measurement of rectal tumour location with a focus on differentiation between mid and high rectal cancer. METHODS: Medical records of 66 rectal cancer patients were reviewed. Tumour location defined at colonoscopy (66 patients), rigid proctosigmoidoscopy (20 patients) and endorectal ultrasound (35 patients) was recorded. Rectilinear and curvilinear methods were used to estimate the distance between the lower tumour level and the anal verge on sagittal CT or MR images (66 patients). Agreement, intra- and inter-observer variation of radiology-based measurements were -assessed using intra-class correlation (ICC) and within-subject coefficient of variation (WSCV). RESULTS: Tumour location was performed at rigid proctosigmoidoscopy in 30% of patients. Intra- and inter-observer agreement for radiology-based measurements were high. Tumour location using the rectilinear method or proctosigmoidoscopy was similar on average, for a difference of only 0.34âcm (SD 2.0 cm, pâ=â0.330), although agreement was -moderate (ICCâ=â0.54, WSCVâ=â16.7%). Measurements based on colonoscopy and the curvilinear radiological method were -characterized by a systematic overestimation of the location, increasing with tumour height. CONCLUSIONS: Radiology-based measurement of the lower tumour level is a reproducible alternative for tumour location at rigid or flexible endoscopy. Its validity should be further assessed.
