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Erschienen in: International Journal of Colorectal Disease 11/2011

01.11.2011 | Original Article

Pelvic abscess associated with anastomotic leak in patients with ileal pouch-anal anastomosis (IPAA): transanastomotic or CT-guided drainage?

verfasst von: Hasan Tarik Kirat, Feza H. Remzi, Bo Shen, Ravi P. Kiran

Erschienen in: International Journal of Colorectal Disease | Ausgabe 11/2011

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Abstract

Aim

Evidence is lacking whether an abscess associated with anastomotic leak after an ileal pouch-anal anastomosis (IPAA) should be drained by transanal or CT-guided drainage. Therefore, the aim of this study was to compare outcomes after the two techniques for drainage.

Method

Patients who underwent IPAA (1984–2009) and diagnosed with a pelvic abscess associated with an anastomotic leak were identified. The choice of operative or image-guided drainage was based on surgeon preference. Differences between patients undergoing transanal (group TA) and CT-guided drainage (group CT) were determined.

Results

Groups TA (n = 53) and CT (n = 18) had similar age (p = 0.3), gender (p = 0.3), body mass index (p = 0.6), steroid use (p = 0.4), albumin level (p = 0.9), ileostomy (p = 0.6), and follow-up time (p = 0.5). The size of the abscess was greater in group CT (p = 0.012). Two patients developed fistula at the CT-guided drainage site. Both healed after conservative treatment and drainage of associated gluteal abscess, respectively. Thirteen patients in group TA and three patients in group CT (p = 0.6) had failure of drainage and underwent surgery. The success rates for the procedures in terms of long-term pouch retention were 75.5% and 83%, respectively, for TA and CT. Groups TA and CT had similar bowel frequency (p = 0.9), incontinence (p = 0.6), urgency (p = 0.9), seepage (p = 0.6), pad usage (p = 0.1), quality of life (p = 0.9), and happiness with surgery (p = 0.9).

Conclusions

There is a risk of fistula at drainage site after a CT-guided drainage of the pelvic abscess associated with anastomotic leak following IPAA. Transanal and CT-guided drainage are equally effective and result in similar long-term pouch-related outcomes.
Literatur
1.
Zurück zum Zitat Meagher AP, Farouk R, Dozois RR, Kelly KA, Pemberton JH (1998) J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 85:800–803PubMedCrossRef Meagher AP, Farouk R, Dozois RR, Kelly KA, Pemberton JH (1998) J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 85:800–803PubMedCrossRef
2.
Zurück zum Zitat Fazio VW, O'Riordain MG, Lavery IC, Church JM, Lau P, Strong SA et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–584PubMedCrossRef Fazio VW, O'Riordain MG, Lavery IC, Church JM, Lau P, Strong SA et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–584PubMedCrossRef
3.
Zurück zum Zitat Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW et al (1995) Ileal pouch-anal anastomosis: complications and function in 1005 patients. Ann Surg 222:120–127PubMedCrossRef Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW et al (1995) Ileal pouch-anal anastomosis: complications and function in 1005 patients. Ann Surg 222:120–127PubMedCrossRef
4.
Zurück zum Zitat Raval MJ, Schnitzler M, O'Connor BI, Cohen Z, McLeod RS (2007) Improved outcome due to increased experience and individualized management of leaks after ileal pouch-anal anastomosis. Ann Surg 246:763–770PubMedCrossRef Raval MJ, Schnitzler M, O'Connor BI, Cohen Z, McLeod RS (2007) Improved outcome due to increased experience and individualized management of leaks after ileal pouch-anal anastomosis. Ann Surg 246:763–770PubMedCrossRef
5.
Zurück zum Zitat Farouk R, Dozois RR, Pemberton JH, Larson D (1998) Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 41:1239–1243PubMedCrossRef Farouk R, Dozois RR, Pemberton JH, Larson D (1998) Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 41:1239–1243PubMedCrossRef
6.
Zurück zum Zitat Sagap I, Remzi FH, Hammel JP, Fazio VW (2006) Factors associated with failure in managing pelvic sepsis after ileal pouch-anal anastomosis (IPAA)—a multivariate analysis. Surgery 140:691–703PubMedCrossRef Sagap I, Remzi FH, Hammel JP, Fazio VW (2006) Factors associated with failure in managing pelvic sepsis after ileal pouch-anal anastomosis (IPAA)—a multivariate analysis. Surgery 140:691–703PubMedCrossRef
7.
Zurück zum Zitat Harisinghani MG, Gervais DA, Maher MM, Cho CH, Hahn PF, Varghese J et al (2003) Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology 228:701–705PubMedCrossRef Harisinghani MG, Gervais DA, Maher MM, Cho CH, Hahn PF, Varghese J et al (2003) Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology 228:701–705PubMedCrossRef
8.
Zurück zum Zitat van Doesburg IA, Boerma D, Bollen TL, van Ramshorst B, Wiezer MJ (2009) Large gluteal abscesses as a complication of transgluteal drainage of pelvic abscesses: analysis of three cases and a search of the literature. Dig Surg 26:329–332PubMedCrossRef van Doesburg IA, Boerma D, Bollen TL, van Ramshorst B, Wiezer MJ (2009) Large gluteal abscesses as a complication of transgluteal drainage of pelvic abscesses: analysis of three cases and a search of the literature. Dig Surg 26:329–332PubMedCrossRef
9.
Zurück zum Zitat Marusch F, Koch A, Scmidt U, Geibetaler S, Dralle H, Saeger HD et al (2002) Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum 45:1164–1171PubMedCrossRef Marusch F, Koch A, Scmidt U, Geibetaler S, Dralle H, Saeger HD et al (2002) Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum 45:1164–1171PubMedCrossRef
10.
Zurück zum Zitat Harisinghani MG, Gervais DA, Hahn PF, Cho CH, Jhaveri K, Varghese J et al (2002) CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome. Radiographics 22:1353–1367PubMedCrossRef Harisinghani MG, Gervais DA, Hahn PF, Cho CH, Jhaveri K, Varghese J et al (2002) CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome. Radiographics 22:1353–1367PubMedCrossRef
11.
Zurück zum Zitat Broder JC, Tkacz JN, Anderson SW, Soto JA, Gupta A (2010) Ileal pouch-anal anastomosis surgery: imaging and intervention for post-operative complications. Radiographics 30:221–233PubMedCrossRef Broder JC, Tkacz JN, Anderson SW, Soto JA, Gupta A (2010) Ileal pouch-anal anastomosis surgery: imaging and intervention for post-operative complications. Radiographics 30:221–233PubMedCrossRef
Metadaten
Titel
Pelvic abscess associated with anastomotic leak in patients with ileal pouch-anal anastomosis (IPAA): transanastomotic or CT-guided drainage?
verfasst von
Hasan Tarik Kirat
Feza H. Remzi
Bo Shen
Ravi P. Kiran
Publikationsdatum
01.11.2011
Verlag
Springer-Verlag
Erschienen in
International Journal of Colorectal Disease / Ausgabe 11/2011
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-011-1272-y

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