Drainage of pelvic abscess through the rectum

Drainage of pelvic abscess through the rectum

Although the ideal place to drain a deep pelvic abscess is through the vagina, it may develop in the cul de sac and present as a bulging mass in the rectal lumen rather than in the vagina.

Drainage through the rectum may be readily accomplished provided the surgeon can be certain that the abscess cavity is fixed to the rectal wall. The incision should be made under direct vision with the anal sphincter sufficiently dilated to permit introduction of retractors to expose the most dependent fixed point.

Manual for the surgeon with pictures (Drainage of pelvic abscess):

Figure 1. The uterus is absent. The abscess is shown dissecting below the pelvic floor to bulge on the rectal side. The arrow points to the optimum drainage site.

Figure 2. The patient is placed in the lithotomy position. When the patient has been anesthetized, the anus is dilated. The surgeon’s two index fingers apply gradual pressure to stretch the anal sphincter. This maneuver should not be hurried or forced if damage to the sphincter is to be prevented.

Figure 3. Narrow blade Richardson retractors should be introduced into the rectum and traction applied to either side.

Figure 4. Allis clamps grasp the rectal mucosa at the point of greatest fixation to the underlying abscess. The surgeon then divides the mucosa in the long axis.

Figure 5. The blunt end of a Kelly clamp is forced into the abscess cavity and the jaws of the clamp are spread.

Figure 6. An exploratory finger bluntly widens the opening and explores the cavity.

Figure 7. The surgeon steadies the lower edge of the incision as he introduces a suction tip to aspirate the cavity. The assistants maintain exposure with the retractors.

Figure 8. The interior of the rectum is shown in relation to the opening into the abscess. No drains are necessary.

COMPLICATIONS DRAINAGE OF PELVIC ABSCESS THROUGH THE VAGINA:

COMPLICATIONS DRAINAGE

COMPLICATIONS DRAINAGE OF PELVIC ABSCESS THROUGH THE VAGINA:

Drainage of pelvic abscess through the rectum

Drainage of pelvic abscess through the rectum

pelvic abscess through the rectum

pelvic abscess through the rectum

pelvic abscess

 

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