Percutaneous vascular and nonvascular puncture under US guidance: role of color Doppler imaging.

Although ultrasound guidance is extensively used in percutaneous interventional procedures, the limitations of B-mode, gray-scale sonographic guidance can restrict clinical use. Little attention has been paid to the use of color Doppler sonography during such procedures. There are several ways in which color Doppler sonography can facilitate percutaneous procedures that involve insertion of a needle or catheter. The advantages of color Doppler sonography include the following: (a) better visualization of the shaft and tip of the needle, especially in solid, echogenic lesions, when the needle is moving, or when the beam-needle angle is narrow; (b) improved targeting of either vessels or non-vascular structures (ie, biliary ducts) to be punctured; (c) avoidance of interposed vascular structures and highly vascular areas during puncture of lesions; (d) improved visualization of poorly echogenic catheters, allowing proper placement; and (e) prompt detection of complications, including active bleeding, after withdrawal of the needle.

CT-guided paracoccygeal drainage of pelvic abscesses.

OBJECTIVE: Using the transrectal/transvaginal routes for the drainage of pelvic abscesses complicating colorectal surgery (anterior resection or abdominoperineal resection) is not always possible. The conventional transgluteal approach through the greater sciatic foramen, although proven to be a valuable access route, can have complications (mainly local pain). MATERIALS AND METHODS: To avoid these difficulties, a CT-guided paracoccygeal-infragluteal approach was used in the percutaneous drainage of deep pelvic (presacral and ischiorectal) abscesses presenting after colorectal surgery in six patients. RESULTS: Percutaneous drainage through this approach was successful in preventing the need for surgery in all six patients. No complications or recurrences were noted, and catheters were removed an average of 15 days after insertion. CONCLUSION: In comparison with the classical transgluteal approach, the paracoccygeal-infragluteal approach minimizes patient discomfort and minimizes the risk of potential injury to the sciatic plexus or blood vessels. This initial series shows that a CT-guided paracoccygeal-infragluteal approach is well tolerated, safe, and effective for the percutaneous drainage of pelvic abscesses developing after colorectal surgery.