Minimally invasive treatment of paracolar abscesses in acute diverticulitis

The OBJECTIVE was to study the informative value of ultrasound examination in patients with paracolar abscess, to evaluate the therapeutic and diagnostic effectiveness of minimally invasive treatment of abdominal and pelvic abscesses in this pathology.
METHODS AND MATERIALS. In the period from 2016 to 2021, 85 patients who underwent minimally invasive drainage of paracolar abscesses were treated under ultrasound and RTV guidance. In 72 (84.7%) patients, the diagnosis was confirmed on MSCT. Transvaginal ultrasound was performed in 12 (14.1%) patients, and transrectal ultrasound was performed in 25 (29.4%) patients. In 18 (21.1%) cases, the diagnosis was determined on pelvic MRI.
RESULTS. Diverticulitis in 65 (76.4 %) patients led to the development of paracolitis, with the formation of intraperitoneal and retroperitoneal inflammatory infiltrates in 40 (47 %) patients and in 25 (29.4 %) patients. Percutaneous drainage was performed in 85 cases. By volume, the abscesses were divided as follows: in 19 (22.3 %) patients, dimensions were 8–10 cm; in 42 (49.4 %) patients, dimensions were 5–8 cm; in 24 (28.2 %) patients, dimensions were up to 5 cm. The most severe group consisted of patients with an abscess volume of 8 to 10 cm. The duration of standing drains in patients with sizes 8–10 cm was 16–18 days, with sizes 5–8 cm–10–14 days, with sizes up to 5 cm – no more than 10 days. Rdical surgical treatment was performed in 15 (17.6 %) patients.
CONCLUSION. A paracolar abscess is an indication for its minimally invasive drainage. We considered the technique of minimally invasive drainage as a possible «bridge» to elective surgery for diverticular disease of the colon. Ultrasound examination has a high sensitivity and specificity in diverticular disease of the colon. This makes it possible to use it not only as a method of primary examination and minimally invasive drainage of the abscess, but also as a way to objectify the dynamics of the affected area of the colon.

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