Retroperitoneal drainage of pelvic abscess

Retroperitoneal drainage of pelvic abscess

Despite the success achieved by intensive antibiotic therapy in the control of pelvic sepsis, abscess formation may appear in the broad ligament or cul de sac and require surgical drainage. It may occur after abdominal or surgical procedures or be the natural development of pelvic disease in the absence of any operative interference.

Complications retroperitoneal drainage of pelvic abscess:

Retroperitoneal drainage of pelvic abscess

Retroperitoneal drainage of pelvic abscess

The location of the pelvic abscess will depend on the site of the original infection and will tend to follow normal tissue planes. The point of election for drainage will depend on the localization. The timing of the drainage is also of great importance. To this end the surgeon should look at the patient as well as the chart. He must assure himself that he will make the incision into an abscess cavity and not an area of porky induration. The palpation of soft tender areas in an otherwise firm mass is a fair indication that pus is present.

An abscess localizing in the upper levels of the broad ligament may point above Poupart’s ligament and be palpated there. Drainage may then be established by an incision in the inguinal region which permits exploration of the retroperitoneal space and avoids the danger of contaminating the abdominal cavity. The primary exploration, following the incision, should be made with a syringe and needle. The presence of pus in the aspirate provides ample indication for continuing to establish drainage through the extraperitoneal approach.

Retroperitoneal drainage of pelvic abscess

Retroperitoneal drainage of pelvic abscess

Surgical technique at Abdominal Operations:

Figure 1. The localization of the abscess in relation to the skin incision is shown.

Figure 2. The skin and fat are incised and retracted. The fibers of the external oblique are split in the long axis.

Figure 3. The retractors are introduced below the external oblique muscle on either side of the muscle incision and the wound converted into a transverse field. The internal oblique is then divided in the line of its fibers.

Figure 4. Retractors are placed beneath the muscle on the lower edge as the surgeon gently separates the transversalis fascia and retracts the peritoneum with the palm of the hand and extended fingers.

Retroperitoneal drainage of pelvic abscess

Retroperitoneal drainage of pelvic abscess

Figure 5. The indurated wall of the abscess cavity is palpated in the deep recesses of the wound at its base. The peritoneum is held back by a Deaver retractor. Before attempting to incise the abscess cavity, the surgeon should try to aspirate pus by exploring with a needle and syringe.

Figure 6. With presence of pus established and suction tip available to control spillage, the tip of a Kelly clamp is thrust into the abscess and the jaws spread.

Retroperitoneal drainage of pelvic abscess

Retroperitoneal drainage of pelvic abscess

Figure 7. The cavity is then aspirated with the suction tip.

Figure 8. The finger then explores the cavity to break up any compart­ments which might contain pus.

Retroperitoneal drainage of pelvic abscess

Figure 9. A gauze-filled drain is introduced into the cavity and another into the retroperitoneal space.

Figure 10. The muscle is loosely closed around the drains.

Figure 11. The fascia is also loosely approximated with interrupted catgut. A word of caution is necessary: At no point in the drainage tract should the drains be constricted; looseness of closure is emphasized.

Retroperitoneal drainage of pelvic abscess

Retroperitoneal drainage of pelvic abscess

 

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