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Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Drainage of Pelvic Abscess

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Days to weeks
Success rate
80-95% (Image-guided)
Recurrence
5-15%

What it is

What is Drainage of a Pelvic Abscess?

Drainage of a pelvic abscess is a procedure to remove a collection of pus from the pelvic cavity. Pelvic abscesses can arise from various sources, including complications of surgery (like an anastomotic leak), diverticulitis, appendicitis, or inflammatory bowel disease. The goal of drainage is to control the source of infection, relieve symptoms such as pain and fever, and prevent more serious complications like systemic sepsis. The drainage can be performed through several routes, depending on the location, size, and accessibility of the abscess.

Common Drainage Techniques

  • Percutaneous Drainage: This is the most common method, where a needle and then a drainage catheter are inserted through the skin into the abscess under imaging guidance (CT or ultrasound). The catheter is left in place to drain the pus.
  • Transrectal Drainage: For abscesses located low in the pelvis and adjacent to the rectum, a catheter can be placed through the rectal wall into the abscess. This is often performed by a surgeon in the operating room or by an interventional radiologist.
  • Transvaginal Drainage: In females, abscesses in the pouch of Douglas can be drained through the vaginal wall.
  • Surgical Drainage: For complex, multiloculated, or inaccessible abscesses, an open or laparoscopic surgical procedure may be necessary to wash out the abscess cavity and place drains.

Am I a candidate?

Who is a Good Candidate for Drainage?

Any patient with a confirmed, symptomatic pelvic abscess is a candidate for drainage. The ideal candidate has a well-defined, unilocular (single-cavity) abscess that is safely accessible via a percutaneous or transrectal/transvaginal route. Patients who are clinically stable are ideal for image-guided drainage, while patients who are unstable or have signs of diffuse peritonitis may require immediate surgical exploration. The choice of technique depends heavily on the patient's anatomy and the specific location of the abscess.

Recovery

What is the Recovery Like?

Recovery depends on the underlying cause of the abscess and the drainage method. After percutaneous or transrectal/transvaginal drainage, many patients experience rapid improvement in their symptoms within 24-48 hours. The drainage catheter typically remains in place for several days to weeks, until the drainage has significantly decreased and follow-up imaging confirms resolution of the collection. Patients are usually managed in the hospital with intravenous antibiotics initially. Recovery from surgical drainage is longer and depends on the extent of the operation performed.

Risks & considerations

What are the Risks?

Risks are dependent on the drainage method but are generally low. Potential risks include:

  • Bleeding: Injury to a blood vessel during catheter placement can cause bleeding.
  • Injury to Adjacent Organs: The needle or catheter can inadvertently puncture the bowel, bladder, or other pelvic structures, potentially creating a fistula.
  • Infection: The procedure can introduce new bacteria, or drainage can be incomplete, leading to persistent or recurrent infection.
  • Catheter-related Issues: The drain can become blocked, dislodged, or cause discomfort.
  • Failure to Resolve: Some abscesses, particularly those that are thick or multiloculated, may not drain completely and may require a more invasive procedure.

Sources

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