Analysis of risk factors for presacral abscess after radical resection of middle and low rectal cancer.

Background and ObjectivesTo investigate the risk factors of presacral abscess after radical resection of middle and low rectal cancer. MethodsClinical data of 2279 patients with middle and low rectal cancer in the department of Colorectal Surgery at the Changhai Hospital of the Second Military Medical University from January 2015 to December 2018 were analyzed retrospectively. Univariate and multivariate analyses were performed to find the risk factors of presacral abscess using Chi-square test and Logistic regression, respectively. ResultsThe median age of all cases was 62 years. Of the 27 cases with presacral abscess, 22 were males and 5 were females. 12 cases were low rectal cancer and 15 cases were middle rectal cancer. Univariate Chi-square test indicated that the relative factors associated with the presacral abscess were tumor size, operative time, blood loss, T stage lesions, receiving preoperative radiotherapy and with preventive terminal ileostomy. Multivariate analysis showed that tumor size, operative time, blood loss, receiving preoperative radiotherapy and with preventive terminal ileostomy were the independent risk factors. ConclusionsPatients with big tumor size, long operative time, high blood loss and preoperative radiotherapy are high-risk groups of presacral abscess after radical resection of middle and low rectal cancer.

Common Options and Overlooked Alternative for Drainage of Inaccessible Presacral Abscess: A Case Report

Purpose. To demonstrate options and alternative for drainage of inaccessible presacral abscess by the example of a rare clinical case of pyogenic spondylodiscitis, transsacraly drained under a combination of two interventional techniques – CT-guided bone biopsy and abscess drainage.Materials and methods. A 55-year-old patient with history of recurrent paravertebral abscesses previously treated with antibiotic therapy was referred to our institution experiencing lower back pain and weakness in both lower extremities. Computed tomography revealed pyogenic spondylodiscitis along with left facet joint destruction and presacral abscess located in ventral sacral surface. Due to inaccessible abscess location, it was decided to perform CT-guided percutaneous transsacral abscess drainage. An 8G bone marrow biopsy needle was used to penetrate the sacrum and create a path for drainage catheter placement. Using the Seldinger technique 8 Fr drainage catheter was inserted into abscess cavity.Results. Neither early nor late procedure-related complications occurred. Sixteen days after drainage procedure, the catheter was withdrawn as patient’s condition improved and the outflow of pus had reduced considerably.Conclusions. Despite being rarely used, CT fluoroscopy-guided transsacral drainage approach is considered to be minimally invasive and in some cases the only viable option for drainage of pyogenic spondilodiscitis of the lumbosacral junction.

Perforated sigmoid diverticulitis masquerading as multiple intra and extra abdominal disseminated abscesses

Abscess formation in perforated diverticulitis is most commonly confined to the pelvis, with other intraperitoneal and extraperitoneal locations rarer in the literature. Presented here is the case of a 63-year-old male who was diagnosed with perforated diverticulitis which manifested in multiple intra- and extra-abdominal abscesses. These were identified on abdominopelvic computed tomography to include a presacral abscess, bilateral psoas abscesses, a large left flank abscess located between the internal and external oblique muscles, as well as osteomyelitis of the S1 vertebra. To the best of the authors’ knowledge, this is the first reported case in the literature with this disseminated constellation of abscesses secondary to acute perforated diverticulitis.

Large presacral abscess in a patient with Crohn’s disease

A presacral abscess with sacral osteomyelitis and gluteal abscesses is a very rare complication of Crohn’s disease and is often clinically unsuspected or overlooked. We report a case of a 58-year-old male who presented for right hip pain after a fall. An abdominal and pelvic CT scan showed an atypical presacral abscess with a fistulizing tract extending through the sciatic notch and lateral to the gluteus medius and minimus muscles forming an intramuscular abscess. The endoscopic transanal approach was used to drain the presacral abscess. This method of drainage was successful and the patient had a favorable prognosis.

Treatment of lumbosacral tuberculosis by anterior internal fixation combined with computed tomography angiography

Objective: This study aims to examine the iliac vascular space in patients with lumbosacral tuberculosis and to evaluate the feasibility of anterior internal fixation for lumbosacral tuberculosis. Methods: A retrospective analysis was performed in 36 patients with lumbosacral tuberculosis. The preoperative three-dimensional computed tomography angiography images were analyzed for anatomical parameters. Results: There were large variations among the anterior lumbosacral iliac vessels. Predominantly, the left iliac vein and the right iliac artery formed the two borders of the triangular iliac vascular space in the coronal plane. The mean distance between the iliac vessels straddle point and the inferior endplate of L5 was 15.01 ± 15.08 mm. In the sagittal plane, presacral abscess increased the distance between the posterior iliac vessel and the anterior vertebra. The distances on the left and right sides were 9.94 ± 6.03 and 10.15 ± 5.46 mm, respectively, at the inferior endplate of L5 and were 11.90 ± 6.97 and 11.68 ± 5.52 mm, respectively, at the superior endplate of S1. Conclusions: The space on sagittal plane occupied by presacral abscess may push forward the vessels and therefore provide opportunities for anterior internal fixation.