85 - Utility of Bifemoral Head-Line on Computed Tomography for Predicting the Feasibility of Drainage of Deep Pelvic Abscesses Through Transrectal Approach

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Poster Presenter(s)

Ahmad Arar, MD

Research Assitant
University of Texas Southwestern, United States

Author/Co-author(s)

JS

Jayesh Soni, MD

Assistant Professor
UTSouthwestern, United States
Seung Kwon Kim, MD, FSIR, MBA (he/him/his)

Professor
Department of Radiology, UT Southwestern Medical C, United States
DL

Daniel Lamus, MD

Assistant Professor
University of Texas Southwestern Medical School Program, United States
Rihin P. Chavda, MD

IR/DR Resident
Interventional Radiology, UT Southwestern Medical Center, United States
GK

Girish Kumar, MD

Associate Professor
UTSW, United States
Anil K. Pillai, MD, MBA

Professor
University of Texas Health Science Center, United States
Rakesh K. Varma, MD

Associate Professor
University of Pittsburgh, United States

Purpose: Transrectal drainage of deep pelvic collections is associated with less pain and lifestyle disruption compared to transgluteal drainage. It is relatively better tolerated and is typically used for short-term drainage when the collection is in close proximity to the rectum. However, data on the accessibility of deep pelvic collections via a transrectal approach are lacking. Our retrospective study aims to describe an imaginary line identified on preprocedural computed tomography that may predict the feasibility of transrectal drainage for deep pelvic collections.

Materials and Methods: This single-center retrospective study included patients who underwent successful transrectal drainage between January 2017 and August 2022. Successful transrectal drainage was defined as the placement of a drainage catheter into the abscess, confirmed by both the drainage of the collection and visualization on fluoroscopy.

We defined a reference line, termed the bifemoral head line, by connecting the tops of both femoral heads on pre-procedure CT scans in the coronal plane. The objective of this study was to assess the utility of this line in predicting the technical success of the procedure. We compared the percentage of abscesses with their inferior margin at or below the bifemoral head line to those situated above it. Additionally, we measured the distance from the lowest aspect of the target pelvic abscess to the bifemoral head line. Complications associated with the procedure were also documented.

Results: A total of 83 abscesses were drained. 95.3% of patients with successful treatment had a lowermost aspect of the abscess below the described reference line. The average size of abscesses was 52.2 cm. The patients had a mean age of 48.3 years. The average catheter size used was 9.8 fr, and the average duration of catheter dwell time was 4.6 days. The overall complication rate was 31.3%.

Conclusion: The bifemoral head line could help predict the technical success rate of transrectal drainage, as over 95% of successfully drained abscesses were found below this line.