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Objective To describe our technique and share our experience with image-guided transrectal drainage (TRD) of pelvic abscesses in children. Materials and Methods Retrospective review and analysis of indications for image-guided TRD and examination of procedural outcomes in pediatric patients with pelvic abscesses over 8 years. Results A total of 69 patients (33 males and 36 females) with symptomatic pelvic abscesses underwent image-guided TRD. The median age and weight of the patients were 11.5 years (range, 3–18) and 46.8 kg (range, 15.1–118.0), respectively. The etiologies of the pelvic abscesses were perforated appendicitis (72.5%) and post-operative collections (27.5%). All patients presented with abdominal pain. Fever, emesis, and diarrhea were also common symptoms. The size of the pelvic abscesses ranged from 24.0 to 937.1 mL (median, 132.7). Technical success was achieved in 68 of 69 TRD procedures (98.6%). Clinical improvement was observed in all patients with technically successful TRD. The TRD catheter dwell time ranged from 0 to 10 days (median, 4.0). Most patients who underwent TRD for perforated appendicitis subsequently underwent elective appendectomy after the resolution of the pelvic abscess (84.0%). The median time from TRD to elective appendectomy was 2.8 months (range, 0.3–6.1). There were no procedure-related complications. Conclusion Image-guided TRD is a safe and effective procedure with high technical and clinical success rates for the treatment of pelvic abscesses in children. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background This study aimed to compare low Hartmann’s procedure (LHP) with abdominoperineal resection (APR) for rectal cancer (RC) regarding postoperative complications. Method RC patients receiving radical LHP or APR from 2015 to 2019 in our center were retrospectively enrolled. Patients’ demographic and surgical information was collected and analyzed. Propensity score matching (PSM) was used to balance the baseline information. The primary outcome was the incidence of major complications. All the statistical analysis was performed by SPSS 22.0 and R. Results 342 individuals were primarily included and 134 remained after PSM with a 1:2 ratio (50 in LHP and 84 in APR). Patients in the LHP group were associated with higher tumor height (P

A 52-year-old male patient presented with complaints of abdominal and back pain. CT revealed a deep pelvic abscess extending into the anterior sacral space. Since puncture via the conventional transgluteal approach cannot reach a deep abscess, percutaneous pelvic abscess drainage was performed under CT fluoroscopy using the cranio-caudal puncture technique. The cranio-caudal puncture requires needle insertion perpendicular to the CT cross-section. This method advances the CT gantry deeper than the needle tip and follows the CT cross-section with the needle tip. This series of images and movements continues until the needle reaches the target. The procedure was successful without complications, the abscess was reduced in size, and blood test data improved. The cranio-caudal puncture technique provides an alternative for the drainage of deep pelvic abscesses that avoids the complications associated with gluteal muscle puncture. Percutaneous drainage of pelvic abscesses under CT fluoroscopy-guided cranio-caudal puncture offers a safe option as a puncture route for deep pelvic abscesses.

Aim: The aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis. Method: This is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right‐sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage. Results: Of the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75–6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32–5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19–0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2–4.75 and OR = 12.95, 95% CI = 9.11–18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted. Conclusion: AL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery. [ABSTRACT FROM AUTHOR]

Complex pelvic masses with elevated CA125 could be due to malignant and benign condition. Tubo-ovarian abscess, with irritation of the peritoneum, could increase the level of CA125 and mimic advanced ovarian cancer. Preoperatively, high accuracy radiological evaluation can reduce the high risk and unnecessary laparotomies. The patient was a 50-year-old near menopause woman with abdominal pain, fever and recent vaginal bleeding with highly elevated CA125(>4000 u/ml) and complex pelvic mass, suspected of ovarian cancer with final pathology of tubo- ovarian abscess (TOA). Misdiagnosed TOA with ovarian cancer only based on highly elevated CA_125 and performing upfront radical surgery in stable patients could result in visceral injury. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare low Hartmann's procedure (LHP) with abdominoperineal resection (APR) for rectal cancer (RC) regarding postoperative complications. Method: RC patients receiving radical LHP or APR from 2015 to 2019 in our center were retrospectively enrolled. Patients' demographic and surgical information was collected and analyzed. Propensity score matching (PSM) was used to balance the baseline information. The primary outcome was the incidence of major complications. All the statistical analysis was performed by SPSS 22.0 and R. Results: 342 individuals were primarily included and 134 remained after PSM with a 1:2 ratio (50 in LHP and 84 in APR). Patients in the LHP group were associated with higher tumor height (P < 0.001). No significant difference was observed between the two groups for the incidence of major complications (6.0% vs. 1.2%, P = 0.290), and severe pelvic abscess (2% vs. 0%, P = 0.373). However, the occurrence rate of minor complications was significantly higher in the LHP group (52% vs. 21.4%, P < 0.001), and the difference mainly lay in abdominal wound infection (10% vs. 0%, P = 0.006) and bowel obstruction (16% vs. 4.8%, P = 0.028). LHP was not the independent risk factor of pelvic abscess in the multivariate analysis. Conclusion: Our data demonstrated a comparable incidence of major complications between LHP and APR. LHP was still a reliable alternative in selected RC patients when primary anastomosis was not recommended. [ABSTRACT FROM AUTHOR]

Background: Vaginal cuff dehiscence (VCD) in the setting of acute infection is an uncommon but serious complication of total hysterectomy without clear guidelines for management. There is a need for further documentation of best practices around treatment, particularly when it comes to surgical drain utilization and placement. Case description: We present a case of a 68-year-old with primary peritoneal carcinoma who underwent a robot-assisted total laparoscopic hysterectomy as part of an interval debulking surgery and had a VCD. The cuff was repaired vaginally in the operating room with placement of a Malecot catheter for pelvic abscess drainage. Discussion: The literature is sparse in regard to clear guidelines for management of VCD. Surgical and expectant management approaches are dependent on patient stability, surgical experience, local practice norms, and evidence of intra-abdominal injury. Interventional radiology has become a primary source of drain placement in management of VCD and vaginal cuff abscess. Malecot drains are a low cost, and effective intervention for such management and an important resource for the gynecologic surgeon.

Objectives: Deep pelvic abscesses are surrounded by the pelvic bones, bladder, gynecological organs, intestinal tract, and nerve and vascular systems, and are approached by various routes for drainage. The transgluteal approach is often performed under computed tomography guidance; however, if ultrasonography can be used to confirm the approach, it is considered more effective because it reduces radiation exposure and allows for real-time puncture under sonographic and fluoroscopic guidance. Methods: This retrospective study was conducted at Tobata Kyoritsu Hospital (Fukuoka, Japan) between April 1, 2021, and December 31, 2022. Sonographically guided transgluteal drainage with fluoroscopy was performed in five consecutive cases of deep pelvic abscesses using a 3D image analysis system (SYNAPSE VINCENT) to study the anatomy for safe puncture. Results: Three patients had postoperative abscesses from colorectal cancer, one caused by perforation of the appendicitis, and one caused by sigmoid diverticulitis. The average drainage duration was 11 days (SD = 6.7). No complications, such as bleeding or nerve damage, were observed. Conclusions: We constructed a 3D image of the puncture route of the trans greater sciatic foramen using SYNAPSE VINCENT to objectively comprehend the anatomy and puncture route. The ideal transgluteal approach is to insert the catheter as close to the sacrum as possible at the level of the infrapiriformis. The parasacrum infrapiriformis approach can be performed safely and easily using ultrasound guidance and fluoroscopy.

Pelvic abscesses located in the uterovesical space usually appear postpartum after cesarean delivery. Late presentation after months or years following surgery is rarely reported, especially in immunocompetent patients. We report the case of a young patient presenting an abscess of the uterovesical pouch, infiltrated in the myometrium, posterior wall of the bladder and parametrium. The case particularities include limited identifiable predisposing risk factors, acute onset of symptoms and belated diagnosis eight years after her second cesarean. The abscess removal by laparotomy required extensive debridement, total hysterectomy, bilateral salpingectomy and partial cystectomy, with good outcome after surgical treatment. We highlight the importance of a mixt urogynecology team for individualized case management and we discuss similitudes with other late cesarean complications.

A meta‐analysis study was executed to measure the effect of minimally invasive surgery (MIS) and open surgical management (OSM) on wound infection (WI) in female's cervical cancer (CC). A comprehensive literature study till February 2023 was applied and 1675 interrelated investigations were reviewed. The 41 chosen investigations enclosed 10 204 females with CC and were in the chosen investigations' starting point, 4294 of them were utilizing MIS, and 5910 were utilizing OSM. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilized to compute the value of the effect of MIS and OSM on WI in female's CC and by the dichotomous approaches and a fixed or random model. The MIS had significantly lower WI (OR, 0.23; 95% CI, 0.15–0.35, p < 0.001) with no heterogeneity (I2 = 0%) and postoperative aggregate complications (PACs) (OR, 0.49; 95% CI, 0.37–0.64, p < 0.001) in females with CC and compared OSM. However, MIS compared with OSM in females with CC and had no significant difference in pelvic infection and abscess (PIA) (OR, 0.59; 95% CI, 0.31–1.16, p = 0.13). The MIS had significantly lower WI, and PACs, though, had no significant difference in PIA in females with CC and compared with OSM. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta‐analysis. [ABSTRACT FROM AUTHOR]

Pelvic abscesses located in the uterovesical space usually appear postpartum after cesarean delivery. Late presentation after months or years following surgery is rarely reported, especially in immunocompetent patients. We report the case of a young patient presenting an abscess of the uterovesical pouch, infiltrated in the myometrium, posterior wall of the bladder and parametrium. The case particularities include limited identifiable predisposing risk factors, acute onset of symptoms and belated diagnosis eight years after her second cesarean. The abscess removal by laparotomy required extensive debridement, total hysterectomy, bilateral salpingectomy and partial cystectomy, with good outcome after surgical treatment. We highlight the importance of a mixt urogynecology team for individualized case management and we discuss similitudes with other late cesarean complications. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: In elective gastric surgeries, gastrojejunostomy is the most common anastomosis being done in both benign and malignant conditions. Anastomotic leak, bleeding, wound infection, and anastomotic stricture are important complications associated with intestinal anastomosis. Both double-layer and single-layer anastomosis are well-established techniques for gastrojejunostomy. Till now, there are no definite concluding findings that determine the suitability of either technique. Aims and Objectives: To compare the utility of single-layer gastrointestinal anastomosis versus double-layer gastrointestinal anastomosis in terms of post-operative outcome. Materials and Methods: A hospital-based prospective comparative study was conducted in the department of general surgery BSMCH with a time frame of about 1/2 years. A total no of 52 patients of the adult age group (18–80 years) admitted in the department of general surgery underwent gastrointestinal anastomosis has been studied. Results: Twenty-six (50%) patients underwent single-layer gastrointestinal anastomosis. The rest 26 (50%) underwent double-layer anastomosis. There is no statistically significant difference between these two groups in terms of post-operative nausea vomiting (P=0.73419), wound infection (P=0.385332), anastomotic leak (P=0.552003), and pelvic abscess (P=0.4924). However, the duration of surgery (P

Sigmoid diverticulitis can potentially lead to the development of pelvic abscesses. Mortality rate from intra-abdominal abscesses is as high as 35%, and patients with diverticulitis complicated by an abscess are at a high risk of recurrent diverticulitis. Recently, image-guided drainage has been performed using computed tomography or ultrasonography for the treatment of pelvic abscesses. Standard radiological pelvic abscess image-guided drainage methods consist of transabdominal, transgluteal, or cranio-caudal puncture approaches. However, these standard approaches have technical limitations due to intrapelvic organ structures. Therefore, we performed image-guided drainage using a percutaneous trans-bladder approach with a simpler 1-step puncture method and a less invasive 7-Fr drainage catheter in 2 cases of a 72-year-old female and a 53-year-old female with relapsed pelvic abscesses complicated by sigmoid diverticulitis due to difficulties involving the standard approach. The abscesses in both cases disappeared on follow-up computed tomography scans, demonstrating no pelvic abscess recurrence. Our results showed that trans-bladder image-guided drainage is an effective alternative method for treating pelvic abscesses.

Background: In elective gastric surgeries, gastrojejunostomy is the most common anastomosis being done in both benign and malignant conditions. Anastomotic leak, bleeding, wound infection, and anastomotic stricture are important complications associated with intestinal anastomosis. Both double-layer and single-layer anastomosis are well-established techniques for gastrojejunostomy. Till now, there are no definite concluding findings that determine the suitability of either technique. Aims and Objectives: To compare the utility of single-layer gastrointestinal anastomosis versus double-layer gastrointestinal anastomosis in terms of post-operative outcome. Materials and Methods: A hospital-based prospective comparative study was conducted in the department of general surgery BSMCH with a time frame of about 1/2 years. A total no of 52 patients of the adult age group (18-80 years) admitted in the department of general surgery underwent gastrointestinal anastomosis has been studied. Results: Twenty-six (50%) patients underwent single-layer gastrointestinal anastomosis. The rest 26 (50%) underwent double-layer anastomosis. There is no statistically significant difference between these two groups in terms of post-operative nausea vomiting (P=0.73419), wound infection (P=0.385332), anastomotic leak (P=0.552003), and pelvic abscess (P=0.4924). However, the duration of surgery (P<0.0001) and hospital stay (P=0.0179) was significantly less in single-layer gastrointestinal anastomosis. Conclusion: Double-layer gastrointestinal anastomosis offers no definite advantage over single-layer anastomosis in terms of post-operative complications. Considering the duration of the anastomosis procedure and hospital stay, singlelayer gastrointestinal anastomosis may prove the optimal choice in most surgical situations. [ABSTRACT FROM AUTHOR]

Postoperative abscess after colpocleisis is rare. We reported a 67-year-old woman with an abscess after a month of Le Fort colpocleisis. Two abscesses of approximately 5 cm in size were drained. The injection of antibiotics continued up to 7 days after the surgery, and the drain was taken on the 4th day after the operation due to the improvement of the patient's general conditions and no discharge. It is recommended to consider pelvic abscess in patients suffering from fever, pain, pelvic pressure, and diarrhea after pelvic surgeries. Early diagnosis and treatment will reduce mortality and disability in patients. [ABSTRACT FROM AUTHOR]

This is a retrospective study to evaluate the safety and efficacy of endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) in a single hospital setting. The referral criteria for EUS-PAD included patients with a pelvic abscess (PA) that was amenable for the procedure. A total of 14 patients with PA treated with EUS-PAD were included in this study. The mean patient age was 57.4 years, and male-to-female ratio was 7:7. Overall, there were six cases of appendiceal perforation, five of rectal cancer and one case each of the diverticular perforation, perianal abscess, and walled-off necrosis. Overall, 100% of procedures were successful. Clinical success was achieved in 11 patients and they were discharged after EUS-PAD within 21.4 days on an average and the average duration of stent placement before removal was 27.0 days. Of all, six patients achieved complete improvement status where the cause was appendiceal perforation while two and one of the patients were recovered where the causes were post-curative operation for carcinoma and walled-off necrosis, respectively. Eight out of eleven patients who exhibited appendiceal perforation or underwent radical rectal cancer surgery were discharged after an average of 9.4 days post EUS-PAD. Although two patients showed temporary improvement, with perianal abscess and controlled rectal carcinoma, the PA worsened as the primary disease intensified. The PA drainage was ineffective in three patients where two of them had uncontrolled rectal cancer and one had diverticular perforation. Conclusively, the EUS-PAD is not only a reliable, safe, and efficient alternative to surgical and percutaneous drainage but also a valuable procedure with a high success rate for patients with acute infections, such as those who have had an appendiceal perforation or curative surgery. Poor indications and contraindications for EUS-PAD include uncontrolled gastrointestinal perforation and direct tumor invasion. [ABSTRACT FROM AUTHOR]

Purpose: The literature reports a varying occurrence (3–33%) of blowout of the rectal remnant after Hartmann's procedure, and there is a lack of multivariate analyses on potential risk factors for blowout following Hartmann's procedure. We aimed to estimate the incidence of blowout within 90 days after a primary Hartmann's procedure and to identify potential risk factors for blowout through multivariate analysis. Methods: A retrospective cohort study was conducted at the Department of Surgery, Aarhus University Hospital, a Danish primary and tertiary hospital. Patients who underwent primary surgery with Hartmann's procedure irrespective of surgical setting and indications between September 2016 and August 2021 were included. Blowout was defined as a defective closure line of the rectal stump or a pelvic abscess. Results: A total of 178 patients were included, and blowout occurred in 30 patients (16.9%) within 90 days after a primary Hartmann's procedure. Multivariate analysis showed increased risk of blowout among patients with Hinchey IV diverticulitis (relative risk 6.32 (95% CI 4.09–9.75)), previous radiotherapy (relative risk 3.35 (95% CI 1.67–6.74)), and alcohol overconsumption (relative risk 1.69 (95% CI 1.05–2.72)). Intraoperative insertion of a Foley catheter in the rectal remnant significantly reduced the risk of blowout within 90 days after a primary Hartmann's procedure (relative risk 0.18 (95% CI 0.05–0.65)). Conclusion: Blowout remains a severe and common complication within 90 days after a primary Hartmann's procedure. Hinchey IV diverticulitis, pelvic radiotherapy, and alcohol overconsumption are risk factors. An intraoperatively inserted rectal Foley catheter is a protective factor and can be considered used in all patients undergoing Hartmann's procedure. [ABSTRACT FROM AUTHOR]

Tailgut cysts are congenital anomalies that are rare and arise from incompletely regressed primitive hindgut. These are more commonly found in women and are usually asymptomatic. When symptoms develop, these can present with pain, infection, hemorrhage, difficulty in defecation, and rarely malignant change. We report a middle-aged married woman who presented with deep-seated perineal pain for a couple of months, which increased during defecation and sexual intercourse. Although abdominal examination was unremarkable barring deep tenderness in the hypogastrium, rectal and vaginal examinations suggested a tender pelvic swelling. An abdominal ultrasonographic examination diagnosed a cystic swelling in the pelvis extending until the Levator ani muscles. Considering her symptoms, a pelvic abscess was diagnosed and transvaginal drainage was done. Due to persistence of symptoms and recurrence after a month, she was further investigated and was diagnosed to have a presacral benign cystic tumor based on CT and MRI scans of the pelvis. The lesion was completely excised through a combined abdomino-perineal approach and histopathological report suggested a benign tailgut cyst. That a cystic presacral swelling with features of inflammation can be confused with a deep pelvic abscess is hereby highlighted in this report. An MRI scan is diagnostic of these lesions. Failure to differentiate it from a pelvic abscess may result in drainage, which may be of concern if the lesion is malignant.

Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses. [ABSTRACT FROM AUTHOR]

As an emerging minimally invasive technology, endoscopic ultrasound (EUS) has been reported to treat pelvic abscess instead of surgical or image-guided percutaneous drainage (PCD) under certain conditions. The aim of this study was to assess the efficacy and safety of EUS-guided drainage for patients with pelvic abscesses. We conducted a comprehensive literature search on PubMed, Embase, Cochrane Library, and Web of Science databases (inception–March 2022). The main outcomes were technical success, clinical success, and complications. Comprehensive meta-analysis software was used to calculate the pooled event rate. Twelve studies containing 272 patients were included. These pelvic abscesses most frequently developed after abdominal and pelvic surgery (n = 180, 66.2%), inflammatory bowel disease (n = 32, 11.8%), and other inflammatory conditions. Respectively, the pooled technical and clinical success rate was 100% and 88.7% [95% confidence interval (CI): 83.8–92.2%, I2 = 1.0%, p < 0.001]. After excluding an individual study, the pooled rate of complications changed from 11.5% (95% CI: 7.4–17.4%, I2 = 38.8%, p < 0.001) to 8.2% (95% CI: 5.0–13.3%, I2 = 0, p < 0.001). EUS-guided drainage of the pelvic abscess was feasible, effective, and safe. Further randomized-controlled studies with large-sample sizes were required in the future. [ABSTRACT FROM AUTHOR]

The patient presented with abdominal pain for the first time 10 years ago and was diagnosed with a left ureteral calculus, left hydronephrosis, and hydroureter. The patient's abdominal pain disappeared after palliative treatment, but he refused any treatment measures for his calculus and hydrops. He was readmitted due to chronic pelvic pain 8 years ago and was diagnosed with a pelvic abscess and left renal atrophy after imaging examination. We performed pus aspiration treatment under the guidance of transrectal B-mode ultrasound and used antibiotic fluid for purulent cavity rinse, followed by intravenous injection of antibiotics. The abscess shrank in follow-up magnetic resonance imaging (MRI), and the pain symptom disappeared in his pelvic. We followed up with the patient for 6 months, and he had no symptoms related to his pelvic abscess that was diagnosed before. Recent abdominal computed tomography (CT) images revealed that his left kidney atrophy still exists, and a pelvic stone was found at the site of the original abscess. This case once again proves that a ureteral calculus should be treated in time; otherwise, it can lead to serious complications such as a pelvic abscess and renal atrophy. A pelvic stone can be caused by a ureteral calculus migration. Minimally invasive treatments have minimal damage to the body and are widely applicable, and the patient was cured by one of them, abscess aspiration, which implies that they can also be used for patients who cannot tolerate surgical procedures., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Bo-Ran An et al.)

Abstract A 66‐year‐old man with perianal pain was found to have a tender erythematous mass on the left side of the anus. Thoracoabdominal computed tomography with contrast enhancement showed a massive anorectal abscess extending from the rectum to the perianal area. The final diagnosis was anorectal abscess caused by rectal cancer.

Background. Pelvic abscess surgery consists mostly of open laparotomy and laparoscopic surgery. Open surgery is regarded as a classic procedure. With the rise and promotion of laparoscopic indications in recent years, comparative studies of the two's postoperative effectiveness have been limited. Objective. To compare the clinical effects of laparoscopic exploratory surgery and open surgery in the treatment of pelvic abscess. Methods. Through computer searches of PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases, we found publicly available case-control research on laparoscopic surgery and open surgery for treating pelvic abscess. The papers that met the evaluation criteria were screened, and meta-analysis was used to look at 8 papers on laparoscopic surgery and open surgery for treating pelvic abscess from 2010 to 2021. Results. The results of this study showed that compared with the open laparotomy group, the incidence of laparoscopic group in the incision infection rate (RR = 0.29 , 95% CI (0.20, 0.41), and P < 0.00001), the incidence of intestinal injury (RR = 0.08 , 95% CI (0.04, 0.14), and P < 0.00001), incidence of intestinal obstruction (RR = 0.26 , 95% CI (0.08, 0.90), and P = 0.03 < 0.05), and postoperative pelvic abscess recurrence rate (RR = 0.34 , 95% CI (0.13, 0.86), and P = 0.02 < 0.05) are lower than open surgery, and the difference of these four items is statistically significant. There was no difference in the risk of urinary tract injury between laparoscopic surgery and open surgery (RR = 0.92 , 95% CI (0.27, 3.17), and P = 0.89 > 0.05). Conclusion. In terms of incision infection, intestinal damage, intestinal obstruction, and recurrence of pelvic abscess, the laparoscopic group clearly outperforms the open group, and it merits clinical promotion and use. [ABSTRACT FROM AUTHOR]

An abscess is a common disease worldwide and its diagnosis is usually straightforward. However, pelvic abscess is rarely seen in daily clinical practice. Besides, it is a challenge for the surgeon to diagnose abscesses in unusual location, including the pelvis. A 41-year-old housewife lady had a history of poorly controlled insulin-dependent diabetes mellitus with recurrent vaginitis, cervicitis, and recurrent urinary tract infection. She presented with bilateral hip joint pain and limitation in her movement, with diabetic ketoacidosis. She was admitted to the hospital for the treatment of diabetic ketoacidosis. A physical examination revealed a high-grade fever, unwell, and there is a pelvic mass. Laboratory tests showed leukocytosis and a low hemoglobin level. Ultrasonography and computerized tomography revealed a 5 × 5 pelvic mass, which was located anterior to the bladder, with a high suspicion of an abscess formation. The patient was admitted to the surgical ward and drainage of the abscess under general anesthesia with antibiotic cover was performed. The patient was discharged two weeks postoperatively with an improvement in all presenting features. Bilateral insidious hip joint pain with limitation of movement should orient the clinician to a pelvic abscess as one of the differential diagnoses of these symptoms. [ABSTRACT FROM AUTHOR]

Objective  We sought to characterize the incidence and risk factors associated with developing maternal morbidity following preterm prelabor rupture of membranes. Study Design  Retrospective case–control study of patients with preterm prelabor rupture of membranes at a single institution from 2013 to 2019 admitted at ≥23 weeks gestational age. The primary outcome was a composite of maternal morbidity which included: death, sepsis, intensive care unit (ICU) admission, acute kidney injury, postpartum dilation and curettage, postpartum hysterectomy, venous thromboembolism, postpartum hemorrhage, postpartum wound complication, postpartum endometritis, pelvic abscess, postpartum pneumonia, readmission, and/or need for blood transfusion were compared with patients without above morbidities. Severe morbidity was defined as: death, ICU admission, venous thromboembolism, acute kidney injury, postpartum hysterectomy, sepsis, and/or transfusion >2 units. Demographics, antenatal, and delivery characteristics were compared between patients with and without maternal morbidity. Bivariate statistics and regression models were used to compare outcomes and calculate adjusted odd ratios. Results  Of 361 included patients, 64 patients (17.7%) experienced maternal morbidity and nine (2.5%) had severe morbidity. Patients who experienced maternal morbidity were significantly (p  < 0.05) more likely to be older, have private insurance, have BMI ≥40, have chorioamnionitis at delivery, and undergo cesarean or operative vaginal delivery when compared with patients who did not experience morbidity. After controlling for confounders, cesarean delivery (aOR 2.38, 95% CI[1.30,4.39]), body mass index ≥40 at admission (aOR 2.54, 95% CI[1.12,5.79]), private insurance (aOR 3.08, 95% CI[1.54,6.16]), and tobacco use (aOR 3.43, 95% CI[1.58,7.48]) were associated with increased odds of maternal morbidity. Conclusion  In this cohort, maternal morbidity occurred in 17.7% of patients with preterm prelabor rupture of membranes. Private insurance, body mass index ≥40, tobacco use, and cesarean delivery were associated with higher odds of morbidity. These data can be used in counseling and to advocate for smoking cessation. Key Points 17.7% of patients with PPROM experienced maternal morbidity. BMI ≥40 was associated with higher odds of maternal morbidity. Tobacco use and cesarean delivery were associated with higher odds of maternal morbidity. [ABSTRACT FROM AUTHOR]

Spontaneous rupture of the urinary bladder represents a rare condition that may complicate with paravesical abscess. Although Staphylococcus aureus may be a part of the intestinal tract flora, it is an unusual cause of abdominal or pelvic abscesses. We report the case of a male patient with spontaneous bladder perforation with osteomyelitis and paravesical abscess, secondary to community-acquired methicillin-resistant Staphylococcus aureus infection.

Abstract It is important to identify a retained fecalith and remove that infective nidus to decrease the morbidity in patients undergoing laparoscopic appendectomy for perforated appendicitis.

A case of pregnancy combined with pelvic abscess after oocyte retrieval and IVF -ET in a patient with ovarian endometriotic cyst was reported. This patient aged 24 years, with infertile for 4 years and polycystic ovary syndrome for 1 year, underwent vaginal ovarian cyst puncture. Diane-35 menstruation treatment was given for 1 cycle. After preoperative examination, assisted reproductive treatment was performed. After 10 days of ovulation extraction and IVF -ET, patient suffered from abdominal pain and fever. After anti -inflammatory therapy failed, laparoscopic exploration was performed, pelvic abscess and acute pelvic inflammation were diagnosed. After that, the pelvic abscess removal and drainage were performed again. Intravenous anti - inflammatory was given after the operation. The patient was cured and discharged. The data of this case were analyzed, and 8 cases of pelvic abscess after assisted reproduction were combined and reviewed, in order to improve the understanding of related complications after assisted reproduction. Infertile patients with ovarian endometriotic cyst were more likely to develop pelvic abscess after oocyte retrieval in the past. In addition, chronic pelvic inflammatory disease, vaginitis and the history of repeated operations are of three risk factors of pelvic abscess. The main clinical manifestations of pelvic abscess are abdominal pain and fever. Patients should be treated actively once diagnosed. If antibiotic treatment failed, surgical treatment should be considered in time. [ABSTRACT FROM AUTHOR]

The incidence rates of pressure ulcers (PUs) in patients with SCI in the United States varies by clinical setting, ranging from 0.4%-38% in acute care, 2.2%-23.9% in long-term care, and 0%-17% in home care [1,2]. Unrelieved pressure is the most important factor in the development of PUs. Other factors associated with PUs in patients with SCI include age at the time of injury, men, blacks, completeness of the injury, functional dependence, behavioral protective factors such as frequent pressure relief, self-positioning, daily skin monitoring, nutritional state, cigarette smoking, alcohol (ab)use, and being depressed [3]. Presence of PUs affects functional physical outcomes; thus, prevention of PUs is the key [4]. Infection is a common complication of PUs which can be local such as cellulitis or osteomyelitis or systemic such as septicemia with a greater than 50% mortality. We present a case of a 58-year-old paraplegic man with pressure ulcer who presented with fever in the presence of an osteomyelitis and had a pelvic abscess on magnetic resonance imaging which needed surgical drainage.

Pelvic collections may occur after surgery or in medical diseases. EUS transmural (TM) treatment has been shown as highly effective and safe, becoming an alternative to surgery or radiology. We aimed to assess the results of EUS management of pelvic collections. Retrospective, single-center observational study conducted between 2004 and 2018. Patients with symptomatic collections treated by EUS-TM approach were enrolled. The procedures were performed with a therapeutic EUS-scope, following two possible options: puncture-aspiration-injection of antibiotics PAIA (group 1) or EUS-drainage by plastic double pigtail stents (DPS) with an ano-cavitary drain (ACD) or lumen-apposing metal Stent (LAMS) (group 2). The main objective was to assess the clinical effectiveness based on symptoms and collection resolution. Seventy-three patients were included. Mean age was 42.5 years [12–87]. 30 patients in group 1 (41%) underwent PAIA and 43 in group 2 (59%) underwent DPS ± ACD in 41 patients (95%) and LAMS in 2. The collection was postoperative in 58%. The mean size was 48.9 mm [8–120], 33 +/- 17 mm in group 1, compared to 67 ± 21 mm in group 2 (p <.0001). All the procedures were technically successful. Overall clinical success was 96% (93% in group 1 (28/30), 98% (42/43) in group 2). Failures occurred in 2 post sigmoiditis abscesses and 1 ileo-colic Crohn's disease. No adverse event was reported. During the median follow-up of 7.5 years [4.4–8.9], no patient had recurrence. EUS-TM with either PAIA or drainage depending on the collection size is confirmed to be highly effective and safe. [ABSTRACT FROM AUTHOR]

Mesonephric‐like adenocarcinoma (MLA) is a rare tumor that occurs in the uterine endometrium and ovary. It morphologically and immunohistochemically resembles cervical mesonephric adenocarcinoma (MA). Here, we present a case of MLA of the ovary along with a literature review. An asymptomatic 84‐year‐old woman presented with a pelvic mass, detected by computerized tomography. Magnetic resonance imaging demonstrated a polycystic mass with a solid component in the left adnexal region. The solid component showed low signal intensity on T2‐weighted imaging and high signal intensity on diffusion‐weighted imaging. We strongly suspected an ovarian malignant tumor; therefore, surgical resection of the uterus and adnexa was performed. Macroscopically, the tumor was predominantly solid with yellowish‐tan cut surface. Microscopically, it showed a tubular pattern with intraluminal colloid‐like material resembling MA. The tumor cells were negative for estrogen receptor, calretinin, and CD10 and positive for PAX8 and TTF‐1. These findings are consistent with those of MLA. [ABSTRACT FROM AUTHOR]

Chronic anastomotic leaks present a daunting challenge to colorectal surgeons. Unfortunately, anastomotic leaks are common, and a significant number of leaks are diagnosed in a delayed fashion. The clinical presentation of these chronic leaks can be silent or have low grade, indolent symptoms. Operative options can be quite formidable and highly complex. Leaks are typically diagnosed by radiographic and endoscopic imaging during the preoperative assessment prior to defunctioning stoma reversal. The operative strategy depends on the location of the anastomosis and the specific features of the anastomotic dehiscence. Low colorectal anastomosis (i.e. following low anterior resection) may require a transanal approach, transabdominal approach, or a combination of the two. While restoration of bowel continuity is encouraged, it is not infrequent for a permanent ostomy to be required to maximize patient quality of life. [ABSTRACT FROM AUTHOR]

This 5-year retrospective study aimed to investigate whether early surgical management improves outcomes in patients presenting with a tubo-ovarian abscess (TOA). Patient characteristics, investigation results and treatment outcomes were compared. 50 women were diagnosed with a TOA during the study period. Nineteen (38.0%) were treated with antibiotics (medical group) and thirty one (62.0%) were treated surgically on admission (early surgical group). The early surgical group was associated with a high success rate of 96.8% and the lowest risk of readmission within 12 months (16.1%). There was no significant difference in the length of stay between the early surgical and the successful medical group. What is already known on this subject? Tubo-ovarian abscess (TOA) is an inflammatory mass that forms most commonly as a complication of untreated pelvic inflammatory disease (PID). Traditionally, TOAs are treated first with broad-spectrum intra-venous antibiotics, with surgical intervention considered after 72 h. It is not known whether early surgical intervention would be beneficial to patient outcomes compared to traditional management. What do the results of this study add? In this study, we have demonstrated a high success rate with early surgical management. Readmission rate was lowest in the early surgical group compared to the medical and late surgical group. This suggests that early surgical intervention may be beneficial, compared to the standard management of trialling antibiotics and then proceeding to surgery 72 h later. What are the implications of these findings for clinical practice and/or further research? Our study suggests that early surgery may be beneficial in the management of TOAs. Although we were unable to demonstrate statistical significance, our data suggest that it would be worthwhile to investigate white blood cell (WBC) and C-reactive protein (CRP) further as a potential predictor for failure of medical management. In the future, more studies comparing early surgical management with medical and late surgical management could inform clinicians of the best mode of treatment for these patients. [ABSTRACT FROM AUTHOR]

Actinomycosis is a rare bacterial condition that is seen infrequently and no studies have examined its prevalence or incidence globally. The author, a stoma care clinical nurse specialist (CNS), found herself caring for two such patients 3 weeks apart, both of whom were diagnosed with pelvic actinomycosis. Both patients had been fitted with copper intrauterine devices (IUDs) 10 years previously and were not aware that leaving IUDs in situ for a prolonged period increased their risk of infection. This article gives an overview of the condition, with discussion around the two patients the author cared for within her own specialty; not all aspects of the condition are included as the she has no clinical experience in microbiology and is not a gynaecological CNS. The case studies show how both women presented and were treated, with interventions including emergency surgery, long-term antibiotic therapy and stoma formation. Pelvic actinomycosis is often associated with the use of an IUD, and greater awareness about the risk of leaving IUDs in situ for prolonged periods is needed among gastrointestinal, colorectal and gynaecological practitioners. [ABSTRACT FROM AUTHOR]

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Background: Mycotic aneurysms are rare vascular lesions, occurring in 0.6–2% of arterial aneurysms but with no reported venous cases. Venous aneurysms unrelated to an underlying infectious process have been previously described and are typically surgically repaired due to risk of thromboembolic events. Case presentation: This case reports a bleeding external iliac vein mycotic aneurysm secondary to erosion of a chronic pelvic abscess, successfully treated with endovascular stenting, in an oncologic patient without alternative therapeutic options. Conclusion: Venous aneurysms are uncommon vascular lesions which have historically been treated with open surgical repair. Given the lower degree of procedural morbidity, endovascular management of these lesions may be an effective option in the appropriate setting, particularly as a last resort in patients without surgical treatment options. [ABSTRACT FROM AUTHOR]

Endogenous endophthalmitis (EE) is an ophthalmological emergency. We report the long-term outcome of bilateral methicillin-resistant Staphylococcus aureus EE in a 23-year-old healthy immunocompetent athlete who presented with EE secondary to pelvic abscess and remained with excellent vision. [ABSTRACT FROM AUTHOR]

Primary fallopian tube cancer (PFTC) is a rare gynecological malignancy. PFTC can be diagnosed by surgery performed for another reasons. We report two cases of PFTC presenting with different referral symptoms. Both patients were postmenopausal. PFTC was detected after surgery for pelvic relaxation in one case, and after surgery for peritoneal carcinomotosis in the other. The distinction between PFTC and ovarian cancer (OC) is difficult because of the similarity of tumor presentations and histologies. As well as the histopathological similarities, treatment protocols of PFTC and OC are similar. Cytoreductive surgery is preferred in both diseases. Therefore in our cases colectomy besides the complete surgical staging were performed to achieve optimal debulking. [ABSTRACT FROM AUTHOR]

It is important to identify a retained fecalith and remove that infective nidus to decrease the morbidity in patients undergoing laparoscopic appendectomy for perforated appendicitis. [ABSTRACT FROM AUTHOR]

Background: Ovarian torsion is a gynecologic emergency rarely reported in women age 75. Appropriate diagnosis helps avoid a delay in treatment. This reports on a rare case of ovarian torsion in a-75-year-old woman, a case that caused diagnostic confusion. Case: A 75-year-old hysterectomized woman presented with lower abdominal pain, difficulty with and painful micturition, and an ill-defined tender mass occupying her suprapubic and right iliac fossa. There was no guarding or rigidity. Ultrasonography (USG) revealed a complex solid cystic mass in her pelvis with vascularity. Contrast magnetic resonance imaging (MRI) showed a well-defined, complex, solid cystic lesion in the midline of the pelvis, with peripheral enhancement, suggestive of chronic collection with a hemorrhagic residua or abscess. Results: An emergency laparotomy revealed a left ovarian cyst with thrice torsion. Cut section revealed hemorrhagic fluid. A histopathology report revealed that this was a simple serous cyst with changes secondary to torsion. Conclusion: This case had typical USG and MRI findings of ovarian torsion is central avascular stroma and multiple, small, peripherally placed uniform follicles. This phenomenon might not be seen in postmenopausal women, due to depletion of ovarian follicles. A twisted vascular pedicle sign might not be seen prominently in hysterectomized old-age women, due to loss of a dual blood supply and atrophy of the pelvic ligaments and vessels. Although a typical feature of infarction in ovarian torsion seen on MRI is heterogeneous minimal or absent enhancement, some cases of torsion can present with peripheral enhancement causing this condition to be confused with a pelvic abscess. Although central afollicular stroma, peripherally displaced follicles, and twisted vascular pedicle signs are more common and specific findings in reproductive-age and perimenopausal women, these phenomena might not be seen in postmenopausal women. Ovarian torsion should be considered in women of any age who present with acute lower-abdominal pain. [ABSTRACT FROM AUTHOR]