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佐々木, 光

市病・脳神経外科

変わること，変わらないこと

博士（歯学）・第2233号・（甲第1429号）・平成30年3月31

石川, 宗理

The fluvastatin affects indian hedgehog signaling in endochondral ossification

Higa, K

Kimoto, R

Kojima, T

Dogru, M

Muller-Lierheim, WGK

Shimazaki, J

角膜センター

市病・眼科

Therapeutic Aqueous Humor Concentrations of Latanoprost Attained in Rats by Administration in a Very-High-Molecular-Weight Hyaluronic Acid Eye Drop

立木, 千恵

島村, 唯

森野, 響子

星野, 綾香

西井, 康

松永, 智

菅原, 圭亮

荻原, 将文

多田, 友海

歯科矯正学

解剖学

口腔病態外科学

【I.分子イメージングと遺伝子発現解析による口腔疾患メカニズムの解明】AI による顔面軟組織からの頭部骨格構造の推測

Satou, R

Shibata, C

Takayanagi, A

Yamagishi, A

Birkhed, D

Sugihara, N

衛生学

Delivery of Low-Diluted Toothpaste during Brushing Improves Enamel Acid Resistance

Nozawa, Y

Masuda, K

Arahata, K

Kobashi, Y

Ikeda, K

Suzuki, T

市病・放射線科

市病・消化器内科

Posted at the Institutional Resources for Unique Collection and Academic Archives at Tokyo Dental College,
Available from http://ir.tdc.ac.jp/
Title
Percutaneous trans-bladder drainage of a pelvic
abscess caused by sigmoid diverticulitis: Two case
reports
Author(s)
Nozawa, Y; Masuda, K; Arahata, K; Kobashi, Y;
Ikeda, K; Suzuki, T
Journal Radiology case reports, 18(10): 3675-3679
URL http://hdl.handle.net/10130/6337
Right
This is an open access article under the CC BY-NC-
ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/)
Description
R a d i o l o g y  C a s e  R e p o r t s  1 8  ( 2 0 2 3 )  3 6 7 5 – 3 6 7 9  
Available online at www.sciencedirect.com 
journal homepage: www.elsevier.com/locate/radcr 
Case Report 
Percutaneous trans-bladder drainage of a pelvic 
abscess caused by sigmoid diverticulitis: Two case 
reports ✩ , ✩✩ 
Yosuke Nozawa, MD a , ∗, Koichi Masuda, MD a , Kyoko Arahata, MD b , Yuko Kobashi, MD, 
PhD a , Koshi Ikeda, MD, PhD a , Taiga Suzuki, MD a 
a Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba 
272-8513, Japan 
b Department of Gastroenterology, Tokyo Dental College Ichikawa General Hospital, Ichikawa-shi, Chiba, Japan 
a r t i c l e i n f o 
Article history: 
Received 28 February 2023 
Revised 19 June 2023 
Accepted 23 July 2023 
Available online 9 August 2023 
Keywords: 
Sigmoid diverticulitis 
Pelvic abscess 
Image-guided drainage 
Trans-bladder approach 
a b s t r a c t 
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 com- 
plicated 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 treat- 
ment of pelvic abscesses. Standard radiological pelvic abscess image-guided drainage meth- 
ods consist of transabdominal, transgluteal, or cranio-caudal puncture approaches. How- 
ever, these standard approaches have technical limitations due to intrapelvic organ struc- 
tures. 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, demon- 
strating no pelvic abscess recurrence. Our results showed that trans-bladder image-guided 
drainage is an effective alternative method for treating pelvic abscesses. 
© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington. 
This is an open access article under the CC BY-NC-ND license 
( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) 
✩ Acknowledgments: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit 
sectors. 
✩✩ Competing Interests: The authors declare that they have no conflict of interest. 
∗ Corresponding author. 
E-mail address: nozawaivr@gmail.com (Y. Nozawa). 
https://doi.org/10.1016/j.radcr.2023.07.059 
1930-0433/© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This is an open access article under the 
CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) 
3676 R a d i o l o g y  C a s e  R e p o r t s  1 8  ( 2 0 2 3 )  3 6 7 5 – 3 6 7 9  
Introduction 
A pelvic abscess (PA) is a collection of infected fluid in the 
pouch of Douglas, the fallopian tube, ovary, or parametrium. 
A PA sometimes occurs as a complication after surgery [1] . 
In addition, PAs can also be associated with several medical 
conditions, such as sexually transmitted diseases, pelvic in- 
flammatory disease, appendicitis, diverticulitis, and Crohn’s 
disease [2] . Further, the mortality rate from intra-abdominal 
abscess is as high as 35% [3] , and patients with diverticulitis 
complicated by an abscess are at a high risk of recurrent di- 
verticulitis [4] . 
Recently, image-guided drainage (IGD) has been performed 
using computed tomography (CT) and ultrasonography (US) to 
treat PAs. However, the performance of PA-IGD with a transab- 
dominal, transgluteal, transvaginal, or cranio-caudal puncture 
approach has technical limitations due to the anatomical lo- 
cation of visceral organs, bone structures, and nerve routes [5–
9] . In these challenging PA cases, Raj et al. reported the efficacy 
and safety of PA-IGD using a trans-bladder approach with an 
8-10-Fr drainage catheter [10] . We modified the trans-bladder 
IGD method using a simpler 1-step puncture method and a 
less invasive 7-Fr drainage catheter, and we report 2 cases of 
trans-bladder IGD of PA complicated by sigmoid diverticulitis. 
Case report 
Case 1 
A 72-year-old female, with diabetes and a clinical history of 
sigmoid colon diverticulitis complicated by an abscess, pre- 
sented with hematochezia and abnormal blood test values of 
white blood cells (WBCs) (11,500 /mm 3 ) and C-reactive protein 
(CRP) (2.25 mg/L). A PA measuring 4.5 × 2.6 cm, induced by 
relapsed sigmoid diverticulitis, was diagnosed on a CT scan. 
During hospitalization, PA-IGD was requested by physicians 
because of resistance to the initial antibiotic therapy (cefmeta- 
zole sodium 3 g/d). Therefore, we decided to perform trans- 
bladder IGD because the CT scan revealed that the PA was lo- 
cated at the perivesical space surrounded by the bladder and 
uterus. 
After Foley catheter insertion, we used the drainage instru- 
ment set (Hanaco Drainage Kit-450, Hanaco Medical, Japan) 
to perform trans-bladder PA-IGD. The PA was punctured us- 
ing an 18-gauge Chiba needle with CT guidance at the spine 
position after local anesthesia, and a 7-Fr pigtail catheter 
was inserted into the PA using 0.035-inch wire ( Fig. 1 ). The 
following day, the WBC and CRP counts were improved, at 
7300/mm 3 and 0.22 mg/L, respectively. Hematuria persisted 
Fig. 1 – (A) The pelvic abscess (PA) (4.6 × 2.6 cm) was observed on computed tomography (CT) scan in case 1, surrounded by 
the bladder (b) and uterus (u). (B) A 7-Fr pigtail catheter was deployed in the PA using CT image guidance. (C) The PA 
decreased to 2.8 × 1.1 cm on a CT scan 7 days after the drainage. The 7-Fr pigtail catheter was removed spontaneously. (D) 
The PA disappeared completely 14.6 months after the drainage but a sigmoido-vesical fistula was newly recognized. 
R a d i o l o g y  C a s e  R e p o r t s  1 8  ( 2 0 2 3 )  3 6 7 5 – 3 6 7 9  3677 
Fig. 2 – (A) The pelvic abscess (PA) (5.4 × 3.4 cm) was observed on computed tomography (CT) scan in case 2, surrounded by 
the bladder (b) and uterus (u). (B) The PA was punctured using ultrasonography guidance via the bladder. (C) The 7-Fr pigtail 
catheter was deployed successfully in the PA. (D) The PA disappeared completely on the CT scan 2.7 months after the 
drainage. 
for a few days after drainage but resolved spontaneously. 
The drainage catheter was removed 7 days after drainage, 
while antibiotic therapy was maintained (cefmetazole sodium 
3 g/d). Finally, the patient could be discharged 17 days after the 
drainage; she demonstrated a decreased PA size on follow-up 
CT scans performed 7 days, 2.1 months, 11.9 months, and 14.6 
months postdrainage. However, because of a newly recognized 
sigmoido-vesical fistula 14.6 months after the drainage, endo- 
scopic treatment and colostomy were performed, with no PA 
relapse after surgery. 
Case 2 
A 53-year-old female, who had chronic kidney disease and a 
clinical history of ileostomy for sigmoid diverticulitis compli- 
cated by abscess, presented with abnormal blood test values 
of WBCs (11,900 /mm 3 ) and CRP (15.01 mg/L) and complained 
of back pain. A PA measuring 5.3 × 3.4 cm was detected on 
a CT scan. The PA was induced by sigmoid colon diverticuli- 
tis and was located at the perivesical space surrounded by 
the bladder and uterus on a CT scan. The bladder completely 
collapsed due to anuria. We performed trans-bladder IGD of 
the PA due to resistance to initial antibiotic therapy (tazobac- 
tam, piperacillin hydrate 6.75 g/d) and anatomical limitations. 
We used the same method and drainage instrument set ac- 
cording to US guidance and succeeded to deploy a 7-Fr pig- 
tail catheter into the PA ( Fig. 2 ). WBC and CRP values were 
completely normalized in 11 days. The size of the PA also de- 
creased on follow-up CT scans performed 5 days, 0.7 months, 
and 2.7 months after the drainage. The patient was discharged 
37 days postdrainage and the 7-Fr pigtail catheter was re- 
moved 61 days postdrainage. Relapsed PA was not observed 
in the follow-up period of 16.9 months. 
Discussion 
Trans-bladder PA-IGD with a 1-step puncture method and 7- 
Fr drainage catheter is simple, safe, and effective. It is com- 
parable to Raj’s trans-bladder approach and other puncture 
approaches [10] . Technically, the supine position in the trans- 
bladder PA-IGD procedure also improves patient tolerance 
of the drainage process, as maintaining the supine position 
is easier compared to the prone position. The percutaneous 
suprapubic drainage approach is already an established pro- 
cedure for urinary diversion. In addition, it is possible that the 
use of a 7-Fr drainage catheter alone is sufficient to treat large 
PAs of more than 5 cm as in case 2 [11] . 
Therefore, the establishment of the trans-bladder PA-IGD 
method in addition to existing drainage methods may in- 
crease the probability of successful treatment of PA. 
3678 R a d i o l o g y  C a s e  R e p o r t s  1 8  ( 2 0 2 3 )  3 6 7 5 – 3 6 7 9  
The incidence rate of fistulas caused by colon diverticular 
disease is approximately 4%-20% and sigmoido-vesical fistula 
is the most common (65.0%) [12] . In case 1, trans-bladder PA- 
IGD was considered not to cause the sigmoido-vesical fistula, 
as the drainage catheter tract was located away from the point 
of the sigmoido-vesical fistula of the bladder dome. Moreover, 
in previously reported cases of trans-bladder IGD of PA (n = 16), 
the sigmoido-vesical fistula was not observed as a complica- 
tion [ 10 ,13 ]. The relatively long period of PA shrinking in case 
1 may have influenced the formation of sigmoido-vesical fis- 
tula. 
Abscess formation is a complication of acute colonic diver- 
ticulitis, occurring in 17%-19% of complicated cases [14] . The 
recurrence rate of colonic diverticulitis with abscess and per- 
foration is very high (72.0%) [4] . Moreover, in sigmoid divertic- 
ulitis cases with an abscess, PA cases demonstrate an almost 3 
times higher failure rate (51.0%) of nonoperative management 
compared with pericolic abscess cases (18.0%) [15] . Other risk 
factors of failure of nonoperative management of diverticuli- 
tis complicated by abscess include immunosuppression, di- 
abetes, renal failure, abscess larger than 5 cm, and extra- 
luminal air with more than 20 locules [ 11 ,16 –18 ]. Therefore, 
in these compromised PA cases, sufficient medical follow-up 
with blood tests and CT scans is needed after PA-IGD. 
In addition, the PAs induced by sigmoid diverticulitis in this 
study were recurrent diseases and disappeared after drainage. 
Gaertner et al. concluded that approximately one-third of pa- 
tients with acute diverticulitis complicated by abscess had 
a recurrence after the initial nonoperative management and 
that most recurrences could again be successfully managed 
nonoperatively [11] . Thus, trans-bladder IGD can also be an 
effective treatment option for relapsed PAs. 
In conclusion, trans-bladder IGD is a safe and effective 
treatment option for initial and relapsed PAs and an alterna- 
tive approach to the standard puncture procedure. 
Ethical approval 
All procedures were performed in accordance with the ethi- 
cal standards of the institutional and national research com- 
mittee and with the 1964 Helsinki Declaration and its later 
amendments or comparable ethical standards. Institutional 
Review Board approval was not required for this study as it 
was a case report. 
Patient consent 
Written informed consent was obtained from the patient for 
the publication of this report and any accompanying images. 
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Percutaneous trans-bladder drainage of a pelvic abscess caused by sigmoid diverticulitis: Two case reports

石原, 和幸

微生物学

東京歯科大学学会シンポジウム 口腔内と腸内細菌叢の理解から紐解く歯周疾患 －口腔からのウェルビーイング社会創生への道しるべ－ ２ ディスバイオーシスにおける細菌間相互作用

佐藤, 涼一

Improvement of enamel acid resistance with phosphoric acid sodium monofluorophosphate solution（AP-MFP）

五十嵐, 康夫

№２１：東京歯科医学専門学校昭和２０年９月の卒業式がなぜ「８日」だったのかの再検証

羽毛田, 真佑花

五十嵐, 章智

田代, 憲太朗

三友, 啓介

村松, 敬

保存修復学

№８：歯髄血管再生療法後の組織学的変化：長期例での形態学的検討

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