Name of the Procedure:

Transrectal drainage of pelvic abscess
Common Names: Rectal abscess drainage, TRD
Technical Terms: Transrectal drainage, Pelvic abscess drainage via rectum

Summary

Transrectal drainage of a pelvic abscess is a medical procedure where an abscess, a collection of pus, in the pelvic region is drained using a minimally invasive technique through the rectum. This approach helps to remove the infection and reduce symptoms.

Purpose

The procedure is intended to treat pelvic abscesses, which are often caused by infections in the pelvic area. The primary goal is to drain the abscess to alleviate pain, reduce infection, and prevent the spread of the infection to other parts of the body.

Indications

• Persistent pelvic pain
• Fever and signs of infection
• Abscess confirmed by imaging (e.g., CT scan, MRI)
• Failure of antibiotic treatment
• Patients who cannot undergo surgery due to underlying conditions

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustment or cessation of certain medications as advised by the doctor
• Pre-procedure imaging studies like a CT scan to locate the abscess
• Blood tests to assess overall health and coagulation status

Procedure Description

1. The patient is positioned on their side.
2. Sedation or anesthesia is administered to ensure comfort.
3. A specialized ultrasound probe is inserted into the rectum to precisely locate the abscess.
4. A needle is guided through the rectal wall into the abscess under ultrasound guidance.
5. The abscess is drained using the needle or a small catheter.
6. A drainage catheter may be placed temporarily to ensure complete evacuation of the abscess.

Tools/Equipment: Ultrasound probe, needles, catheters
Anesthesia: Local anesthesia with sedation or general anesthesia

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

Transrectal drainage of a pelvic abscess is usually performed in a hospital or a specialized surgical center.

Personnel

• Interventional Radiologist or Surgeon
• Anesthesiologist
• Surgical nurse or technician
• Radiologic technologist

Risks and Complications

• Infection at the needle insertion site
• Bleeding or injury to nearby organs
• Incomplete drainage leading to recurrence
• Pain or discomfort post-procedure
• Rarely, sepsis or systemic infection

Benefits

• Relief from pelvic pain and discomfort
• Reduction in infection and fever
• Minimal invasiveness with a quicker recovery compared to open surgery
• High success rate with precise abscess drainage

Recovery

• Observation period post-procedure to monitor for complications
• Pain management with prescribed medications
• Instructions on wound care, if applicable
• Avoidance of strenuous activities for a few days
• Follow-up appointments for re-evaluation and possible removal of drainage catheter if placed

Alternatives

• Intravenous antibiotics (may be less effective if the abscess is large)
• Surgical drainage through an abdominal incision (more invasive)
• Peritoneal drainage under CT or ultrasound guidance (less common)

Pros and Cons of Alternatives:

• Antibiotics: Non-invasive but often insufficient for large abscesses
• Surgical drainage: More definitive but involves longer recovery and higher risks

Patient Experience

Patients may experience mild discomfort during the procedure despite sedation. Post-procedure, there may be localized pain which is managed with medications. Most patients report significant relief from the symptoms caused by the abscess shortly after the drainage. Recovery is generally quick, with most patients resuming normal activities within a few days.