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Transgluteal Approach for Percutaneous Drainage of Deep Pelvic Abscesses: 154 Cases¹

¹ From the Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114. From the 2001 RSNA scientific assembly. Received August 1, 2002; revision requested October 1; revision received December 15; accepted January 27, 2003. Address correspondence to M.G.H. (e-mail: mharisinghani@partners.org).

View larger version (165K): [in a new window]   Figure 1. Transverse CT image obtained at the level of the piriformis muscle in a patient with a deep pelvic abscess (black arrow), while the patient was supine. Underlying the gluteus maximus muscle is the piriformis muscle (white arrow), which crosses the center of the greater sciatic foramen. Anterior to the piriformis are the neurovascular structures (arrowhead).

View larger version (164K): [in a new window]   Figure 2. Transverse CT image obtained in a prone patient shows optimal access for transgluteal drainage with the infrapiriformis approach. The needle can be seen transecting the sacrospinous ligament (white arrow) and penetrating a deep pelvic abscess (black arrow).

View larger version (133K): [in a new window]   Figure 3. Transverse CT image obtained in a prone patient shows transgluteal catheter drainage of a presacral abscess that originated from a postsurgical fluid collection (arrow). The catheter has been inserted medially through the piriformis muscle (arrowhead) and kept close to the sacrum to avoid possible injury to the sciatic nerve and gluteal vessels.

View larger version (165K): [in a new window]   Figure 4. Transverse CT image obtained in a prone patient shows a presacral abscess that originated from a postsurgical fluid collection (arrow). The location of the abscess warranted a transpiriformis approach for optimal drainage. The catheter is visible in the piriformis muscle (arrowhead). Immediately after the procedure, the patient experienced pain that spontaneously resolved within 24 hours.