Pelvic Abscess Endoscopic Drainage in Nellore: Procedure, Benefits & More

Pelvic abscess though uncommon, can be seen as a collection of inflammatory purulent (discharge of pus) material that may form secondary to any infection within the pelvis. 

An abscess is an abnormal collection of pus (a yellowish-white fluid that contains white blood cells, dead and damaged tissue, and bacteria) within a confined or walled-off area which may gradually increase in size and when internally present abscesses are left untreated, they may even burst to cause life-threatening complications. Pelvic abscesses are more prevalent among women than men and present with symptoms like abdominal or pelvic pain and discomfort.  It can be managed through conservative (non-surgical) and several surgical methods depending on the size and severity of the condition.

This article will discuss a type of surgical abscess drainage known as endoscopic drainage, the procedure, its benefits, and the risks involved.

A pelvic abscess is a rare form of abscess that commonly occurs in the pelvic region of women. It may begin at the lower genital areas and gradually spread to the fallopian tubes, ovaries, and lower abdomen. If present in men, it is found over the prostrate. This inflammatory collection of pus forms either secondary to any infection (caused by bacteria) in your body, like pelvic inflammatory disease (PID), previous abdominal or gynecological surgeries, trauma, or as a complication of appendicitis (inflammation of the appendix). 

Abdominal and pelvic pain is a classical symptom of a pelvic abscess, along with other symptoms like fever, presence of pelvic mass, vaginal bleeding or discharge, nausea, vomiting, diarrhea (frequent loose stools), and frequent urination.

Treatment of a pelvic abscess depends on the size of the abscess and the severity of the symptoms. 

• Small abscesses do not cause pain or discomfort. They usually go unnoticed, and do not require any treatment. 
• Moderately sized abscesses that cause mild pain can be managed through antibiotics. The antibiotics prescribed depend on the type of bacteria causing the infection, which can be identified through a blood culture test.
• Larger pelvic abscesses cause extreme pain and discomfort, negatively affecting your quality of life and posing a risk of rupture should be treated or drained surgically. There are different types of pelvic abscess drainage:
  • Pelvic abscess laparotomy (open method)
  • Pelvic abscess laparoscopy (minimally invasive)
  • Percutaneous abscess drainage (Ultrasound or CT-guided)
  • Endoscopic abscess drainage (Ultrasound or CT-guided)

A pelvic abscess endoscopic drainage is a minimally invasive (involves minimal pain and trauma to surrounding structures) alternative to other surgical drainage procedures that help drain a pelvic abscess and use a special device called an “Echoendoscope.” 

This medical device differs from a conventional endoscope since an echoendoscope is a long thin tube that contains an ultrasound microphone at one end of the tube, which allows the visualization of the internal abdominal or pelvic region for needle insertion and placement of a catheter (a thin tube used for draining pus). 

The microphone at the tip of the device converts electrical energy into sound energy to help determine the location of the pelvic abscess with the help of ultrasound-guided images.

Endoscopic pelvic abscess drainage is a minimally invasive daycare procedure (does not require hospitalization), which should be performed by a well-trained surgeon and an interventional radiologist to help with image guidance.

• A CT (Computed Tomography) scan will be performed to determine the exact location of the pelvic abscess before pelvic abscess drainage.
• Your surgeon will review your medical history, including any drug allergies, conditions like diabetes (increased blood sugar levels), hypertension (high blood pressure), etc., medications being taken, and a history of previous surgeries to determine your overall health.
• Your surgeon will also prescribe prophylactic antibiotics before the procedure and you will be advised to continue them for 3 to 5 days post-procedure.
• Bowel preparation with an enema will be done prior to the surgery for adequate visualization and to reduce the risk of contamination.
• You would be asked fast 6 to 8 hours before the procedure, especially if general anesthesia will be administered.
• You may be advised to stop medications like blood thinners (that may cause bleeding) or other herbal medications.
• You will be asked to eat a healthy and well-balanced diet to prepare your body to cope with the surgery.
• If you are a smoker and an alcoholic, this may interfere with wound healing and cause complications like infections; hence you may be advised to quit smoking and alcohol at least 1 to 2 weeks before the procedure.
• You should arrange for a family member to drive you home after surgery as you cannot drive due to the effect of anesthetic drugs.

Endoscopic pelvic abscess drainage is a safe procedure performed under fluoroscopy (a medical procedure to analyze the movements internally by injecting a dye and passing X-ray beams through the body). 

• You will be wheeled into the operating theatre and given general anesthesia through IV (intravenous) infusion. This sedates you and puts you to sleep during the entire procedure.  
• The targeted area (located through image guidance from CT or ultrasound) is disinfected using alcohol and prepared for needle insertion.
• Under EUS (endoscopic ultrasound) guidance, a thin fine aspiration (FNA) needle is inserted to puncture the pelvic abscess cavity for fluid collection.
• A normal saline solution is flushed into the cavity using a thin syringe and aspirated to drain the pus and clean the abscess cavity. The pus sample is sent to the laboratory for culture.
• A stent (medical tube-like hollow device) is inserted through which a draining tube (catheter) is introduced to facilitate complete drainage. This is usually placed and secured with surgical tapes until the whole abscess is drained and the infection has reduced.
• The entire procedure takes around 45 to 60 minutes.

After the drainage, you will be kept in a recovery room for observation with continuous monitoring of your vitals like BP (blood pressure), blood sugar levels, pulse, heart rate, and urine output.

• You may expect mild pain and discomfort immediately after the effect of anesthesia wears off.
• You can go home if there are no complications post-drainage procedure. Sometimes, you may need to stay in the hospital for 1 to 2 days.
•  You will be prescribed antibiotics and pain medications to reduce infection and post-op pain and discomfort.
• You will be advised to rest for 2 to 3 days and precautions to be taken for proper healing:
  • Do not take shower for 2 to 3 days
  • Avoid strenuous activities and lifting heavy objects
  • Avoid driving until your drain is removed
  • Avoid tub baths and swimming for at least 2 weeks
• A CT scan will be performed 48 hours post-procedure to evaluate the response to the drainage therapy. If the abscess has decreased in size by more than 50%, the durian is discontinued.
• Recovery usually takes 2 to 3 weeks, depending on how well you respond.

Endoscopic pelvic abscess drainage is a safe and effective alternative to other surgical drainage methods with the following benefits. 

Benefits 

• The procedure does not involve any incisions (cuts).
• Quick healing with shorter recovery time.
• There is no scarring around the surgical site.
• Quick return to work and other routine activities.

Risks 

Though safe and effective, endoscopic pelvic abscess drainage has its own side effects and risks:

• Secondary infection that may cause fever, chills, and body aches.
• Allergic reaction to general anesthesia that may cause hives, rash, dizziness, confusion, and shortness of breath.
• Fear of catheter displacement or blockage may require readjustment or catheter replacement.

There could be occasional bleeding around the catheter being placed.

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