All Answers (23)
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Percutaneous drainage with antibiotics
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there are many Homeopathic remedies like Calc. sulph. etc., to help the abscess drain in natural way
cheers
dr Afser Imam
CEO
AKHTER HUSAIN FOUNDATION
PAKISTAN
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Transanal drainage with antibiotics -
I'm agree with you, transanal drainage with antibiotics is enough -
Drainage (colpotomy/ Tran-rectal, percutaneous/ open) depending on the site and Antibotics! -
If the abscess is significant and bulging, per-rectal drainage with antibiotic cover (which must include Metronidazole) is the best approach
Bimpe Aderounmu -
Laproscopic Drainage , toileting & treating the cause, cover with antibiotic. -
Laparotomy,exploration,probing pus,evacuation pus(antibiotic test),swill,treating the cause,drainage and antibiotic terapy. Dr.Vladescu Viorel
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I think if origin of pelvic abscess is treated and if transeanal drainage is not possible laproscopic drainage is prefered
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TC guided percutaneous declive drainage
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Ct guided drainage -
if it's possibie TC guide percutaneous drainage or lapaoscopic drainage and antibiotic teraphy -
If well localized in the pouch of douglus per rectal drainage and placement of corrugated drain can be performed in an ambulatory settings. However, surgically I believe laparoscopic approach is the best. -
Laproscopic approach is the best, microbiology specimen should be collected and guide antibiotic therapy, leave abdominal drain in site postop, antibiotic therapy post and preop. Whether tubovarian abscess, it should be considered adnexectomy or salpingectomy. If it's acute and tubal mucosa appears only edematous it could be simply drained via linear salpingotomy. Age of the patient is also paramount, older patients have significantly higher rates of complications even life-threatening. -
Most of the pelvic abscesses have some source which needs to be addressed laparoscopcally or by open laparotomy along with thorough peritoneal lavage as well institution of drainage tubes. However for residual pelvic abscess after source control guided percutaneous drainage is a good option
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If the patient is fit for general anaesthesia, laparoscopic approach is the best. You can treat the cause and the peritoneal lavage is more thorough. -
I personally think that there is not "the one" or "the best" treatment of a pelvic abscess. The treatment depends on the etiology, its exact location, the clinical conditions of the patient, etc. etc... All the techniques here proposed could be valid if appropriately selected case by case. But, percutaneous drainage is often insufficient, and since the drainage has to be absolutely complete, other more aggressive options should be applied. Moreover, antibiotic treatment is very rarely effective, because the antibiotic concentration in the abscess cavity is almost null. "Ubi pus ibi evacuat", but evacuation has to be "complete" and achieved in the "shortest time". -
There various ways to deal with pelvic abscess depending on its aetiology, size and morphology. Also, the general condition of the patient must be taken into account.
For postoperative and many other pelvic abscesses, radiologically-guided percutaneous drainage and antibiotics is sufficient. If this does not improve the patient condition or fails to adequately drain the collection,, or for multi-loculated collection, laparoscopic or open drainage must be considered. Trans-anal drainage is also suitable in sleceted cases with unilocular collection. -
Pelvic abscess is usually associated with high morbidity. Mode of intervention has changed from laparotomy and drainage to radiologically guided( USG ) aspiration and laparoscpic drainage to endoscopic drainage. If possible, trans-anal drainage is best with minimal morbidity and fastest recovery. Repeated aspiration under USG guidance is a good option when repeated collection occurs. Laparoscopic drainage prefererred when radiologically guided drainage fails. Open drainage to be done when all the above treatment fails or facility of other intervention is not available. -
Depending upon the situation:-
Per Rectal drainage if localized
Laparoscopic drainage is the choice
In case of multiloculated n chronic, needs open laparotomy n thorough peritoneal lavage n drain.
USG Guided drainage if fluid is not thick enough.
All procedures should be well covered by good antibiotic coverage as morbidity is quite high. -
My approach to the problem of pelvic abscess coincides with the strategy outlined by colleagues Dionigi and Meshikhes: aethiology, morphology and general condition of the patient must be considered before deciding on the type of treatment. -
US drainage, CT drainage, per rectal drainage, laparoscopic drainage, are techniques that work very well in different clinical and anatomical conditions. We must adopt the right technique in the right patient. We have to think in a tailored way -
Unfortunately, the answer to the question "What is the optimal treatment for pelvic abscesses?" sounds like the "optimal method does not exist" (in the categorical sense). On the other hand, less categorical answer can sound like «Each method that is adequate to the clinical situation, may be optimal».
Selecting of proper method of treatment of pelvic abscess (open surgery - laparoscopy – USG/СТ controlled puncture or drainage - transanal drainage) should be based on detailed assessments them by origin, cause, location, size, condition of the adjacent affected organs and the general condition of the patients.
I agree with the views of colleagues Giorgio Vasquez, Alessandro Uzzau, abdul-Wahed Meshihes, Renzo Dionihi - in surgery, If you have multiple methods of treatment, the main art is promptly (Sic!) choose the proper method of treatment for a particular clinical situation.
