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At least 559 records · Page 31Linked to original sources
PubMed2007

Special anoscope for easy purse-string suture application in stapled hemorrhoidopexy.

BACKGROUND: Internal hemorrhoids and loose rectal mucosa may block exposure during the purse-string suturing in stapled hemorrhoidopexy, and this may lead to complications. MATERIALS AND METHODS: To retract the prolapsing rectal mucosa, we modified the purse-string anoscope of the PPH01 kit (Ethicon-Endosurgery, Cincinnati, OH, USA) and produced a special anoscope. The open part of the purse-string suture anoscope is covered by transparent acrylic (Orthoacryl, Dentaurum, Pforzheim, Germany). The covering had completely cylindrical outer and inner surfaces and was thin enough to let the anoscope easily rotate in the anal dilator and to let the 26 mm curved, round-bodied needle of the 2/0 polypropylene suture move in the anoscope. A window, 3 cm long and 3-4 mm wide, was opened at the angled part of the anoscope 2 cm to the tip. This special anoscope was used for the purse-string suture during the stapled hemorrhoidopexy procedure in five patients. RESULTS AND CONCLUSIONS: No postoperative complications, early or late, were encountered, and we propose that stapled hemorrhoidopexy procedure can be applied more easily by using this special anoscope.

Equipment Design↗
PubMed2003

Rectal inflammation as first manifestation of graft-vs-host disease: radiologic-pathologic findings.

Graft-vs-host disease (GVHD) is a common, life-threatening complication of bone marrow transplantation that frequently involves the gastrointestinal tract. Since symptoms are typically nonspecific, radiologic examination is often performed to reach a diagnosis. To the best of our knowledge, this is the first reported radiologic description of a case of rectal involvement as the first manifestation of GVHD. The differential diagnosis of segmental rectal wall thickening in a patient following bone marrow transplantation should include GVHD.

Abdominal Pain↗
PubMed2002

Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection.

BACKGROUND AND AIMS: The minimally invasive technique of transanal endoscopic microsurgery (TEM) combines the benefits of local resections, a low complication rate and high patient comfort, with low recurrence rate and excellent survival rate after radical surgery (RS). The use of an ultrasonically activated scalpel rather than electrosurgery further improves the results of TEM. PATIENTS AND METHODS: A retrospective study was performed of 182 operations on 162 patients with early rectal carcinoma (pT1, G1/2) or adenoma to compare the outcome following four different kinds of surgical resection techniques: RS (anterior or abdominoperineal resection; n=27), conventional transanal resection using Park's retractor (TP; n=76), transanal endoscopic microsurgery (TEM) with electrosurgery (TEM-ES; n=45), and TEM with UltraCision (TEM-UC; n=34). One-third of the patients with RS (33%) received either a colostomy or a protective loop-ileostomy. RESULTS: Operation time with TEM-UC was significantly shorter than with TEM-ES or RS. Hospitalization was significantly longer with RS than for TEM or TP. Complication rate with TEM was significantly lower than with RS. Recurrence rate with RS and TEM was significantly lower than with TP, with a trend to TEM-UC being better than TEM-ES. Mortality rate was 3.7% with RS and 0 with TP and TEM. The 2-year survival rate was 96.3% with RS and 100% each with TP and TEM. CONCLUSION: TEM using UC seems to be the technique of choice. TP leads to an unacceptable recurrence rate, and RS results in a higher incidence of complication and impairment of life quality.

Adenoma↗
PubMed2005

Short-term preoperative radiotherapy is a safe approach for treatment of locally advanced rectal cancer.

BACKGROUND AND AIMS: The Swedish Rectal Cancer Trial (SRCT) demonstrated that a short term regimen of high-dose preoperative radiotherapy (5x5 Gy) not only reduces the risk of local recurrence but also improves overall survival rate. An increase in postoperative mortality and morbidity has also been observed, however. We therefore evaluated early postoperative complications in patients treated with neoadjuvant radiotherapy for locally advanced rectal adenocarcinoma. PATIENTS/METHODS: Between 2000 and 2004, 85 patients with locally advanced rectal tumors were treated in our institution. Preoperative staging was based on CT scan and, in several cases, on endorectal ultrasonography. They were 55 men and 30 women, with a median age of 68 years. They were retrospectively divided into two groups: Group A, which included 40 patients undergoing preoperative radiotherapy (25 Gy in five fractions) followed by surgery within 1 week, and Group B, which included 45 patients with rectal cancer receiving surgery immediately after diagnosis. Both groups were homogeneous regarding age, gender and preoperative stage of the disease. The two groups were compared for both technical difficulties during operation and rate of postoperative complications. RESULTS/FINDINGS: No postoperative deaths were recorded in either group. Low anterior resection with total mesorectal excision was performed in all group A patients, whereas eight patients in group B underwent abdominoperineal resection (P<0.05). Diverting stoma was performed in seven patients of group A and it was closed 3-6 months later on every occasion. Postoperative morbidity was not statistically significant between the two groups (40 vs 39%). The rate of postoperative hemorrhage, pelvic or abdominal wound infection, acute urinary infection, and delayed ileus was similar. The percentage of major anastomotic leak was also equivalent (5 vs 6.6%). INTERPRETATION/CONCLUSION: Short-term preoperative radiotherapy does not increase the rate of postoperative complications and is a safe therapeutic adjunct for the treatment of locally advanced rectal cancer.

Adenocarcinoma↗
PubMed1996

Is digitation associated with proctographic abnormality?

Constipated patients referred for evacuation proctography were questioned as to the need for digital manoeuvres to assist evacuation, to determine the frequency of digitation, and to investigate whether any proctographic feature was associated with this symptom. Seventy one percent of patients interviewed admitted to digitation. Proctographic findings in 20 constipated patients who digitated per vagina and 20 who digitated per anum were compared to 20 who did not. There was no significant difference between groups with respect to pelvic floor descent, anal canal width or any anrectal angle measurement. Rectocoele depth and area were significantly greater in patients who digitated per vagina, compared to the other two groups. Evacuation time was prolonged and a proctographic diagnosis of anismus more frequent, in patients who digitated per anum. Anal digitation is associated with prolonged evacuation, suggesting a proctographic diagnosis of anismus and vaginal digitation to assist rectal evacuation is significantly associated with large anterior rectocoele.

Constipation↗
PubMed1997

Incremental elastic modulus--a challenge to compliance.

Rectal compliance has theoretical and practical drawbacks resulting in wide variation in the reported normal values. Slope of stress-strain relation, a measure of rectal wall stiffness (Incremental elastic modulus; IEM) may be an effective alternative. The aim of this study was to compare IEM with rectal compliance during ramp inflation. In a group of 15 normal adults [Median age 51.5 years (range 31 to 74); 11 female and 4 male], these parameters were assessed at three rates of inflation, using a proctometrogram-catheter-balloon (PCB) complex and endorectal ultrasound scanner (7 Mhz; B & K) to measure intrarectal pressure and radius respectively. IEM had a linear relation with strain (Slope 33.55; R2 = 0.9815) in contrast to compliance (R2 = 0.0088). Series elastic component (SEC), a measure of passive viscoelasticity, was rate independent elasticity [Slope 1.02 (0.98 to 1.15); P = ns] and a rate dependent viscosity (P = 0.004; One way ANOVA). Both IEM and SEC were reproducible (R = 0.985; P < 0.01). This study emphasises the importance of rectal wall viscoelastic evaluation based on stress and strain rather than compliance.

Adult↗
PubMed1997

Solo operated haemorrhoid ligator rectoscope. A report on 200 consecutive bandings.

A new solo operated haemorrhoid ligator rectoscope is described by the author. This new ligator consists of a double barreled cone, one fitting precisely inside the other. The device functions as a rectoscope to visualize the wall of the ano-rectum and at the same time the distal end of the interior barrel carries the rubber band and functions as the ligator. After the operator grasps the pile and pulls it into the barrel with a tenaculum, he discharges the band by retracting the internal barrel with a simple flick of the thumb. The tool is greatly simplified and more efficient than prior art. It is easy to operate and clean. The view through the rectoscope is clear and unobstructed. The author also reports on a retrospective analysis of his experience with 200 consecutive bandings of symptomatic internal haemorrhoids. The tool proved to be an effective way of rubberbanding haemorrhoids and similar clinical results as with other rubber band devices were attained, with the added bonus that whenever indicated the device allows for a larger amount of tissue to be banded, which may be desirable when treating mucosal prolapse.

Adult↗
PubMed1999

A new grading of rectal internal mucosal prolapse and its correlation with diagnosis and treatment.

The management of rectal internal mucosal prolapse (RIMP) is not based on an accepted classification of the lesion which helps to choose the appropriate treatment. The aim of this prospective study was to report a new endoscopic grading of RIMP and to evaluate its clinical value. Thirty-two patients (7 men, 25 women; mean age 56 years, range 28-72) affected by symptomatic RIMP were prospectively classified as follows: RIMP was defined as first degree when detectable below the anorectal ring on straining, as second degree when it reached the dentate line, and as third degree when it reached the anal verge. Anal manometry was carried out in 26 patients, and anal ultrasound and defecography in 6 prior to surgery. A correlation was found between the occurrence and severity of symptoms and the degree of the prolapse as obstructed defecation, bleeding and fecal soiling affected mainly patients with third-degree RIMP. At manometry the maximal resting tone was 60+/-23 mm Hg and voluntary contraction 96+/-41 mm Hg (mean+/-SEM). At anal ultrasound the mean internal sphincter thickness was 2.1+/-0.2 mm, and external sphincter thickness was 7.0+/-0.8 mm. A significant rectocele and rectal intussusception (n = 2) and a nonrelaxing puborectalis muscle on straining (n = 2) were observed at defecography in cases with third-degree RIMP. The anorectal angle was 100+/-75 degrees at rest, 63+/-20 degrees on squeezing, and 115+/-9 degrees on straining. A conservative treatment with high-fiber diet and/or rubber band ligation was carried out in all cases of first and in most patients with second-degree RIMP (n = 26). Those who required surgery, i.e., stapled transanal excision of the prolapse (n = 6), had either severely symptomatic third-degree RIMP with solitary ulcer syndrome (n = 4) or second-degree RIMP (n = 2). A positive outcome was achieved in 71% of cases. The proposed classification evaluated by the present study may be of clinical value in managing rectal internal mucosal prolapse.

Adult↗
PubMed2002

Topical lidocaine does not limit autonomic dysreflexia during anorectal procedures in spinal cord injury: a prospective, double-blind study.

BACKGROUND AND AIMS: Autonomic dysreflexia is a common and potentially dangerous response in patients with spinal cord injury at T6 or above. Acute blood pressure elevation may be precipitated by rectosigmoid distention and anal manipulation. Topical anesthetics are widely recommended to minimize the incidence and severity of autonomic dysreflexia, although no scientific evidence supports or refutes this practice. This study tested whether topical lidocaine would prevent or limit anorectal procedure-associated autonomic dysreflexia. PATIENTS AND METHODS: We enrolled patients with chronic, complete spinal cord injury scheduled for anoscopy and/or flexible sigmoidoscopy. In a double-blind fashion they were randomized to receive either 2% lidocaine jelly (n = 18) or nonmedicated lubricant (control; n = 32) just prior to the procedure. We measured blood pressure before, during, and after procedures. RESULTS: Mean maximal systolic blood pressure increased 35 +/- 25 mmHg in the lidocaine group vs. 45 +/- 30 mmHg in the control group (NS). However, there was a significant difference between anoscopic procedures and flexible sigmoidoscopies without anoscopy (49 +/- 29 vs. 25 +/- 20 mmHg). CONCLUSION: Topical lidocaine did not significantly limit or prevent autonomic dysreflexia in susceptible patients. Both anoscopy and flexible sigmoidoscopy caused significant blood pressure elevation. Anoscopy, which involves stretching of the anal sphincters, was a more potent stimulus for autonomic dysreflexia than flexible sigmoidoscopy, which involves gaseous distention of the rectosigmoid. Anal sphincter stretch and rectosigmoid distention, rather than a mucosal stimulus, are likely nociceptive triggers for procedure-associated autonomic dysreflexia.

Administration, Topical↗
PubMed2002

Laparoscopic treatment of rectal prolapse: experience gained in a prospective multicenter study.

BACKGROUND: We report the findings of a prospective multicenter observational study carried out by the Study Group for Laparoscopic Colorectal Surgery on patients undergoing laparoscopic or laparoscopic-assisted surgery for rectal prolapse. The study investigated the safety of various laparoscopic techniques in terms of perioperative and postoperative general and technique-specific complications and compared the results with those reported for open surgery in this area. METHODS: Of the 150 patients undergoing laparoscopic or laparoscopic-assisted colorectal surgery for rectal prolapse 124 received rectopexy combined with resection and 26 rectopexy alone. In 85 patients a mesh was employed during rectopexy. The conversion rate was 5.3%. RESULTS: Perioperative complications (21 surgical and 35 general perioperative) were recorded in 37 patients (24.7%). The reoperation rate was 5.3% (bleeding 2, anastomotic leak 2, ileus 4). No procedure-specific perioperative complications were observed. In particular, reduced surgical trauma led to fewer severe postoperative complications such as cardiopulmonary problems (3.3%). CONCLUSIONS: The techniques of conventional prolapse surgery can readily be translated to the laparoscopic modality, since oncological criteria do not have to be considered. The usually elderly patients in this group benefit to a particular degree from the known advantages associated with reduced surgical trauma. Perioperative morbidity is determined largely by the surgeon's experience. We therefore believe that rectal prolapse is a suitable indication for the minimally invasive modality in the hands of trained surgeons.

Aged↗
PubMed2003

Gasless, video endoscopic transanal excision for carcinoid and laterally spreading tumors of the rectum.

BACKGROUND: The aim of this study is to determine whether gasless, video endoscopic transanal-rectal tumor excision (gasless VTEM) is a valid treatment for rectal carcinoid and laterally spreading tumors (LST). METHODS: Eighty-four patients with an adenoma, adenocarcinoma (Tis/T1), or carcinoid tumor of the rectum were divided into three groups: (i) LST ( n = 17 patients), (ii) carcinoid ( n = 11), and (iii) control with other types of tumors ( n = 56). RESULTS: The LST group had a longer median operating time than in the control group, whereas the carcinoid group had a shorter operating time. Two patients (11.7%) in LST group developed peritoneal entry during the operation, while 2 patients (3.6%) in the control group experienced postoperative complications. During a median follow-up length of 55.2 months, one patient in the LST group developed a recurrence. CONCLUSIONS: Gasless VTEM is a simple, minimally invasive procedure used to treat LST and carcinoid tumors of the rectum. However, resection for the LST group had a high risk of peritoneal entry during operation.

Adenocarcinoma↗
PubMed2003

Combining ultrasonic dissection and the Storz operation rectoscope.

BACKGROUND: Transanal endoscopic microsurgery (TEM) allows a precise, full-thickness resection of rectal tumors anywhere within the rectum. Unfortunately, the standard TEM technique needs complex and rather expensive equipment, demands high skill, and is attended by bleeding and oozing that may be challenging. A modified TEM procedure combining the new Storz operation rectoscope and ultrasonic dissection has been developed to overcome the limitations of the original technique. METHODS: The Storz operation rectoscope features a 5-mm telescope combined with a single-monitor display. Standard laparoscopic instruments and the LCSC5 Ultracision Maniple are used for dissection and coagulation. Full-thickness resection is performed most often. Closure of the defect is accomplished by interrupted 3-0 polydoxanone sutures secured by extracorporeal slipknots. RESULTS: Altogether, 18 TEMs have been performed according to the modified technique: 9 for malignant and 9 for benign lesions. The median operating time was 92.5 min for resection of malignant lesions and 40 min for resection of benign lesions. Two postoperative complications occurred: a bleeding and a partial dehiscence. The median follow-up periods were 35 months for malignant disease and 19.5 months for benign disease. No recurrence was observed. CONCLUSION: For tumors located up to 15 cm from the anal verge, TEM with the Storz rectoscope and ultrasonic dissection is indicated. Despite the complication described, coagulation is optimal and ultrasonic scissors allow working in a fairly bloodless field. The overall costs of the equipment are significantly lower.

Adenocarcinoma↗
PubMed2003

Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer.

BACKGROUND: Transanal endoscopic microsurgery (TEM) has gained increasing acceptance as a local treatment of early rectal cancer. The purpose of this study was to compare the results of TEM and radical surgery in patients with T1 and T2 rectal cancer. METHODS: From October 1994 to December 2000, 74 patients with T1 and T2 rectal adenocarcinoma treated with TEM were compared with 100 patients with T1N0M0 and T2N0M0 rectal adenocarcinoma treated with radical surgery. Retrospective analysis was performed regarding to recurrence and survival rate. Neither group received adjuvant chemoradiation. There was no significant difference in age, gender, tumor location, or follow-up period between the two groups. The only difference was in tumor size. RESULTS: Of the 74 patients in TEM group, 52 were T1 (70.3%) and 22 were T2 (29.7%). Of the 100 patients in radical surgery group, 17 were T1 (17%) and 83 patients were T2 (83%). The 5-year local recurrence rates were 4.1% for T1, 19.5% for T2 after TEM, 0% for T1, and 9.4% for T2 after radical surgery. There was no statistical difference between the TEM and radical surgery groups for T1 rectal cancer ( p = 0.95), but for T2 rectal cancer, the 5-year local recurrence rate was higher after TEM than after radical surgery ( p = 0.04). There were no significant statistical difference between the two groups in terms of the 5-year disease-free survival rate and the survival rate. CONCLUSIONS: For T1 rectal cancer, there was no difference in recurrence or 5-year survival rate between the TEM and the radical surgery groups. For T2 rectal cancer, there was no statistical difference in the 5-year survival rate between the two groups, but TEM carried higher risk of local recurrence. Therefore, careful selection of the patients is required for TEM, and when proper muscle invasion is proven, the TEM procedure should be supplemented by further treatment, or radical surgery should be performed.

Adenocarcinoma↗
PubMed2003

Transanal endoscopic microsurgery in the treatment of select rectal cancers or tumors suspicious for cancer.

BACKGROUND: This study describes a personal experience with the use of transanal endoscopic microsurgery to facilitate surgical access, and to determine the ability of this technique to reduce the need for major abdominal procedure and prevent the need for a temporary or permanent colostomy in select patients with known or suspected rectal cancer. METHODS: The subjects of this study were 43 patients with rectal cancer or tumors who had a high likelihood of malignancy. The 24 men and 19 women comprised two groups: patients with known cancer ( n = 16) and patients with tumors suspicious for cancer ( n = 27), six of whom proved to have invasive malignancy. The tumors ranged in size from 1 to 7 cm (average, 3.5 cm). The tumor's inferior level in the rectum ranged from -1 to 21 cm (average, 6.5 cm). Eleven patients known to have rectal cancer were treated with preoperative radiation or chemoradiation. By ordinary standards, 22 patients would have received an abdominal perineal resection; 14 patients would have qualified for abdominal sphincter-preserving operations; and 7 patients were indeterminate. Full-thickness local excisions were disk excisions ( n = 23), hemicircumferential excisions ( n = 19), and sleeve resection ( n = 1). The ages of the patients ranged from 30 to 91 years (average, 66.7 years). RESULTS: In this study, 90% avoided a major abdominal operation (39/43), and 90% avoided an abdominal perineal resection of the patients (20/22). The complications were as follows: mortality ( n = 10), morbidity ( n = 9), minor wound separation ( n = 6), and major wound separation ( n = 3). Two of these complications were rectovaginal fistulas: the one in a 91-year-old patient who presented with a fistula and the other in a 77-year-old patient who presented with a previously irradiated and incompletely excised cancer. A single instance of locally recurrent cancer required an abdominal perineal resection. There were no other recurrences. Overall, three patients required a stoma (7%). CONCLUSION: Transanal endoscopic microsurgery promises to offer a safe and effective option for the selective treatment of patients with rectal cancer after preoperative chemoirradiation, and for the management of tumors suspicious for rectal cancer. Transanal endoscopic microsurgery used selectively can reduce the need for major abdominal surgery and colostomy.

Adult↗
PubMed2003

Transanal endoscopic excision of rectal adenomas.

Transanal endoscopic microsurgery (TEM) is a minimally invasive surgical technique for performing local excision of rectal lesions in the mid and upper rectum that would otherwise be inaccessible for local excision by the direct transanal approach. In the absence of this approach, low anterior resection would be required, which is major abdominal surgery. The justification for excising adenomas of the colon and rectum is their malignant potential, which correlates with the size of the lesion. This retrospective review examines our experience using TEM for excision of adenomas of the rectum from February 1991 to the present. The decision for using TEM is based on a precise localization of the lesion with particular attention to the upper margin of the lesion and its diameter. A total of 56 adenomas were removed. The average diameter was 4.9 cm (range, 3-8 cm). The average distance from the anal verge was 7.92 cm (range, 5-12 cm). Carcinoma in situ was seen in 7 lesions, and the remaining lesions were benign. Morbidity was minimal, with one conversion to an open procedure for an intraperitoneal perforation that required a low anterior resection. No patient required transfusion and there was no mortality. The hospital stay was short, with half of the patients being discharged the same day. The average cost from July 1996 to December 1999 was 7775 dollars for TEM versus 34,018 dollars for LAR. Subsequent follow-up average was 38.8 months (range, 1-100 months), during which time two patients had recurrence of their adenomas. This was successfully treated with reexcision. In conclusion, TEM is an accurate, safe, and relatively inexpensive technique when compared to low anterior resection. This technique significantly reduces the proportion of adenomas requiring abdominal surgery.

Adenoma↗
PubMed2003

Palliation of carcinoma of the rectum using the urologic resectoscope.

BACKGROUND: Thirty percent to 40% of patients with rectal cancer are not candidates for aggressive surgery because of distant metastases, extensive local tumor infiltration, poor general condition, or refusal of the patient. The aim of this study was to report the results of endoscopic transanal resection (ETAR) using a urologic resectoscope for the palliative treatment of rectal carcinoma. METHODS: This study included 46 consecutive patients who underwent ETAR for rectal adenocarcinoma between October 1992 and October 2000. All patients had histologically confirmed adenocarcinoma. None of the patients were candidates for curative surgery. A retrospective evaluation of the outcome of ETAR was performed. RESULTS: Forty-six consecutive patients (25 men and 21 women), with a median age of 84 years (range, 57-92 years), underwent 76 ETARs. Twenty-four patients (52%) had locally advanced rectal cancer with a tumor length of more than 5 cm. The tumor involved the anterior rectal wall in 52 ETARs. Seventeen patients (37%) required more than one procedure. Median operating time was 49 min (range, 15-120 min). The morbidity rate was 8% (n = 6); perforation of the rectum occurred in 1 patient (2%) during an iterative ETAR. The mortality rate was 2%. The median postoperative stay was 5.5 days (range, 3-16 days). Symptomatic relief was achieved in 87% of patients. Colostomy was performed in 8 cases, with a median interval of 7 months (range, 3-12 months) after the first ETAR and after a median of 2 ETARs (range, 1-3). The median survival time was 14 months (range, 0-62 months); 40 patients died. The survival rate at 1, 2, and 5 years was 54%, 31.6%, and 5%, respectively. CONCLUSION: ETAR is a simple, minimally invasive, and economic method that should be part of palliative treatment for patients with rectal carcinoma. ETAR is a useful addition to the surgeon's armamentarium in the multidisciplinary approach of advanced rectal cancer together with laser destruction, stent implantation, and external beam radiotherapy. All these treatments must be evaluated not only in term of lumen patency or stoma rate, but also from the quality of life standpoint.

Aged↗
PubMed2003

Use of head-mounted display in transanal endoscopic microsurgery.

BACKGROUND: Head-mounted display (HMD) decreases the forced adjustments of position and eyes in endoscopic surgery. During transanal endoscopic microsurgery (TEM), these adjustments might even be greater because of the direct viewing technique. We investigated the feasibility of HMD in TEM. METHODS: Head-mounted display is a helmet with two built-in displays. The stereoscopic endoscope (with two separate lens systems) provides separate images at each display. During TEM, standard stereoscopic optic and HMD were alternated. RESULTS: Use of HMD was possible after construction of a special device. The helmet was comfortable to wear, and the peripheral view was adequate. The operator's position was upright and relaxed. The range and depth of vision seemed comparable with those of the standard stereoscopic optic. The quality of the displays in the helmet is limited. CONCLUSIONS: Head-mounted display is feasible in TEM. It enables a more relaxed position and view on the operative field. The quality of the display in the helmet requires improvement.

Adenoma, Villous↗
PubMed2004

Endoscopic ultrasound-guided transrectal aspiration of pelvic fluid collections.

BACKGROUND: The aim of this study was to evaluate the feasibility, safety, and diagnostic accuracy of endorectal ultrasound-guided aspiration and drainage of pelvic fluid collections. METHODS: All patients who underwent endorectal ultrasound-guided aspiration and/or drainage of pelvic fluid collections were included in this prospective study. Patients were prepared using bowel lavage and a single-dose antibiotic combination. The procedure was carried out in the lithotomy position usually without sedation. All aspirates were examined microbiologically and/or cytologically. RESULTS: Twenty-nine patients [18 females and 11 males; median age, 67 years (range, 18-79)] underwent 33 endosonographic controlled aspirations. No procedure-related complications were encountered. In 22 cases (76%) the lesions were encountered following a surgical procedure. Fluid amounts varied between 5 and 750 ml. Fluids were sterile in 14 cases (42%). These fluid collections were hematomas, seromas, peritoneal cysts, and a mucocele. Microorganisms were found in the remaining 19 aspirations (58%), i.e., abscesses (n = 16) and infected hematomas (n = 3). A transrectal (n = 14) or transvaginal (n = 2) drainage catheter was placed in 16 patients under endosonographic guidance. Only two patients required a subsequent laparotomy for definitive treatment of their septic focus, whereas all other patients could be treated successfully by this conservative approach. CONCLUSION: Endoscopic ultrasound-guided transrectal aspiration and drainage of pelvic fluid collections is a safe method with a favorable outcome because it avoids unnecessary operations in selected patients.

Adult↗