Autosomal dominant hyper immunoglobulin E (IgE) syndrome is a rare inborn error of immunity that affects approximately one in a million individuals worldwide. It presents with various symptoms owing to multisystem involvement (immunological and non-immunological). Recurrent infections (mainly in the skin and lungs) are common presentations. A 5-year-old Middle Eastern boy presented with symptoms suggestive of obstructive uropathy secondary to multiple large pelviabdominal abscesses and acute kidney injury with hyperkalemia that necessitated admission to the intensive care unit. Upon further investigation, the patient\'s genetic test (whole exome sequencing) demonstrated a heterozygous missense variant in the STAT3 gene. The patient completely recovered and did not require further admission after initiating prophylactic antibiotics. Although deep-seated infections are uncommon in STAT3 hyper IgE syndrome, skin and lung infections are most commonly observed. Multiple deep collections can occur and require prompt intervention and aggressive treatment.

OBJECTIVE: 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.
METHODS: 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.
CONCLUSIONS: 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.

BACKGROUND: This study aimed to compare low Hartmann\'s procedure (LHP) with abdominoperineal resection (APR) for rectal cancer (RC) regarding postoperative complications.
METHODS: 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.
CONCLUSIONS: 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.

UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.

UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.

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.

UNASSIGNED: Pelvic abscess is a common complication of abdominal surgery or intestinal or gynecological diseases. Over the last decades, endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to percutaneous or surgical treatment of pelvic abscesses.
UNASSIGNED: To evaluate safety and efficacy of EUS-guided transrectal pelvic abscess drainage in a single center.
UNASSIGNED: From February 2017 to April 2023, all data on patients who were treated for pelvic abscesses by EUS-guided drainage in a single center, were retrospectively analyzed.
UNASSIGNED: A total of 17 patients were treated for pelvic abscesses by EUS-guided drainage. The procedure was technically successful and uneventful in all 17 patients (100%). Etiology of the abscess was postsurgical (n=5, 29%), secondary to medical illness (n=10, 59%) or gastrointestinal perforation (n=2, 12%). The abscess was multilocular in 5 patients (29%), the mean largest diameter was 76 mm (range 40-146 mm). Drainage was performed using 2 double pigtail stents, and in 1 patient an additional 10 Fr drainage catheter was deployed. Two patients (12%) required a second endoscopic intervention. Treatment success, defined by complete abscess resolution on follow-up CT scan along with symptom relief, was 100%. There was no need for surgical intervention. The median post-procedural hospital stay was 5 days. No recurrence was reported within a median time of follow-up of 39 months.
UNASSIGNED: EUS-guided transrectal drainage of pelvic abscesses using double pigtail stents is safe and highly effective. This case series contributes to the cumulative evidence that, in expert hands, EUS-guided drainage should be considered as first-line approach for treatment of pelvic abscesses.

UNASSIGNED: EUS is a potential alternative for the drainage of abscesses. The aim of this study was to determine if EUS-guided pelvic abscess drainage is technically feasible, safe, and a valid option for abscess resolution.
UNASSIGNED: We conducted a retrospective review from 2002 to 2020 at a single quaternary institution. EUS-guided pelvic abscess drainage via the transrectal route was performed in all patients with or without drain/stent placement. Technical and clinical success of EUS-guided pelvic abscess drainage was analyzed. Descriptive analyses and Fisher exact test were performed.
UNASSIGNED: Sixty consecutive patients were included in the study (53.5% male; mean age, 53.8 ± 17.9 years). Pelvic abscesses occurred mainly postoperatively (33 cases; 60.0%) and from complicated diverticulitis (14 cases; 23.3%). Mean diameter was 6.5 ± 2.4 cm (80% unilocular). Drainage was performed with EUS-guided stent placement (double-pigtail plastic or lumen-apposing metal) in 74.5% of cases and with aspiration alone for the remainder. Technical success occurred in 58 cases (97%). Of those with long-term follow-up after EUS-guided pelvic abscess drainage (n = 55; 91.7%), complete abscess resolution occurred in 72.7% of all cases. Recurrence occurred in 8 cases (14.5%) and persisted in 7 patients (12.5%), 7 of which were successfully retreated with EUS-guided pelvic abscess drainage. Accounting for these successful reinterventions, the overall rate of abscess resolution was 85.5%. Abscess resolution rate improved with drain placement (83%). Accounting for 7 repeat EUS-guided pelvic abscess drainages, overall abscess resolution improved. Two deaths occurred (3.4%) because of sepsis from failed source control in patients who had previously failed medical, radiological, and surgical treatment.
UNASSIGNED: EUS-guided pelvic abscess drainage is technically feasible, safe, and an effective alternative to radiological or open surgical drainage. It also offers favorable clinical outcomes in different clinical situations.

OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.

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.