RESUMEN
RESUMEN Antecedentes: El drenaje percutáneo es una alternativa a la cirugía en el manejo de los abscesos pélvi cos. El objetivo de este estudio es evaluar la seguridad y la eficacia del enfoque transglúteo. Material y métodos: Los drenajes fueron realizados por 3 cirujanos, bajo guía tomográfica. Se utilizó la técnica de Seldinger, con anestesia local; se utilizaron catéteres de 8 y 10 Fr. El drenaje fue exitoso si la colección desapareció y no había recurrido. Resultados: El promedio de edad de los pacientes fue de 49,2 años. El germen más común fue Esche richia coli. En la mitad de los casos, la causa fue posoperatoria. La duración media del drenaje fue de 9,2 días. El drenaje tuvo éxito en todos los casos, sin complicaciones mayores. Conclusión: El drenaje transglúteo guiado por tomografía computarizada (TC) es seguro y bien tolera do para el tratamiento de abscesos pélvicos profundos.
ABSTRACT Background: Percutaneous drainage is an alternative to surgery in the management of pelvic abscesses. The aim of this study is to evaluate the safety and efficacy of the transgluteal approach. Material and methods: Transgluteal percutaneous drainages were performed by 3 surgeons using computed tomography guidance. The Seldinger technique was used with 8 Fr and 10 Fr catheters under local anesthesia. Drainage was considered successful if the abscess regressed and did not recur. Results: Mean age was 49.2 years. Escherichia coli was the most common microorganism identified. In 50% of the cases, the abscesses occurred postoperatively. Mean duration of drainage was 9.2 days. Drainage was successful in all the cases and there were no major complications. Conclusion: Transgluteal computed tomography-guided approach is safe and well-tolerated for the treatment of deep pelvic abscesses.
RESUMEN
Os procedimentos percutâneos orientados por imagem têm ganhado espaço crescente na radiologia intervencionista, constituindo ferramenta eficaz para a abordagem diagnóstica e terapêutica de massas e coleções nos diversos segmentos corporais. No entanto, localizações pélvicas profundas ainda representam grande desafio para o radiologista, por causa da interposição de estruturas anatômicas. Para que o procedimento seja bem sucedido é fundamental o planejamento da via de acesso baseado no conhecimento detalhado da anatomia radiológica da pelve. As principais vias de acesso para a abordagem destas lesões são: transabdominais (anterior e lateral), extraperitoneal ântero-lateral, transvaginal, transretal e transglútea. O objetivo deste trabalho é fazer uma revisão da anatomia seccional pélvica normal, demonstrando as diversas vias de acesso para biópsias e drenagens guiadas pela ultra-sonografia e pela tomografia computadorizada, bem como discutir as principais vantagens e complicações potenciais de cada uma delas.
Image-guided percutaneous procedures have increasingly been established as safe and effective interventional tools in the diagnosis and management of masses and collections in several body segments. However, lesions in deep pelvic sites still pose a challenge for radiologists because of overlying anatomic structures. The success of a percutaneous biopsy depends on a safe access route planning based on a deep understanding of cross sectional anatomy of the pelvis. Anterior and lateral transabdominal, anterolateral extraperitoneal, transvaginal, transrectal and transgluteal approaches are described. The present study was aimed at reviewing the normal pelvic cross-sectional anatomy, demonstrating the different access routes for ultrasonography and computed tomography guided pelvic biopsies and drainages as well as discussing the main advantages and complications associated with these approaches.