Department of Orthopedics, Shanxi Provincial People's Hospital, Taiyuan Shanxi, China.
Department of Orthopedics, Shanxi Provincial People's Hospital, Taiyuan Shanxi, China.
World Neurosurg. 2021 Sep;153:75-78. doi: 10.1016/j.wneu.2021.07.016. Epub 2021 Jul 10.
Presacral abscess is a common disease in the developing countries. Treatments include minimally invasive percutaneous drainage and open surgical debridement. Percutaneous drainage under computed tomography (CT) guidance has been recommended by the American College of Radiology as a good alternative to surgical drainage before elective surgical treatment. Because of the many anatomic obstacles, the presacral space can be one of the most difficult locations to access. There are several reported access routes like transabdominal, transgluteal, transvaginal, transperineal, transanal, precoccygeal, transpedicular, and so on. We introduce a novel approach, the trans-sacral-foramen approach, to drain presacral abscess under CT guidance.
A 47-year-old woman who had lumbar laminectomy debridement for epidural abscess was diagnosed with residual presacral abscess. She was placed in the prone position. One-step technique was applied. Intermittent CT scans were obtained during drainage catheter (8F) advancement into the sacral posterior foramen. The stylet was withdrawn and an approximately 60° angle for catheter trajectory was used to best reach the sacral anterior foramen due to the inherent pelvic tilt. When the catheter tip reached the presacral abscess, the abscess cavity was aspirated with a syringe, pus was drained, and catheter was fixed to skin. Sensitive antibiotics were administered.
After 2 weeks magnetic resonance imaging (MRI) showed significant reduced abscess and the catheters were removed. At 18-month follow-up, MRI showed intervertebral fusion at the lumbosacral segment.
Trans-sacral-foramen approach is the shortest path to reach the presacral abscess. The approach is easier and safer than the others for patients with indication.
直肠前脓肿是发展中国家的一种常见疾病。治疗方法包括微创经皮引流和开放性外科清创术。美国放射学会推荐在择期手术治疗前，经计算机断层扫描（CT）引导下进行经皮引流，作为手术引流的一种很好的替代方法。由于存在许多解剖学障碍，骶前间隙可能是最难到达的部位之一。有几种报道的入路方法，如经腹、经臀、经阴道、经会阴、经肛门、经尾骨前、经皮等。我们介绍一种新的方法，即经骶骨孔入路，在 CT 引导下引流直肠前脓肿。
一位 47 岁的女性因硬膜外脓肿行腰椎椎板切除术清创，被诊断为残留直肠前脓肿。她被置于俯卧位。采用一步法。在引流导管（8F）推进至骶骨后孔的过程中，间断进行 CT 扫描。当导管尖端到达直肠前脓肿时，用注射器抽吸脓肿腔，排出脓液，并将导管固定在皮肤上。给予敏感抗生素。
2 周后磁共振成像（MRI）显示脓肿明显缩小，导管被取出。18 个月随访时，MRI 显示腰骶段椎间融合。
经骶骨孔入路是到达直肠前脓肿的最短路径。对于有适应证的患者，该方法比其他方法更容易、更安全。
