Background:

Presacral abscess is a common disease in the developing countries. Treatments include minimally-invasive percutaneous drainage and open surgical debridement. Percutaneous drainage under CT guidance has been recommended by the American College of Radiology as a good alternative to surgical drainage before elective surgical treatment. Due to the many anatomic obstacles, the presacral space can be one of the most difficult locations to access. There are several reported access routes like transabdominal, transgluteal, transvaginal, transperineal, transanal, precoccygeal, transpedicular and so on. We introduced a novel approach, trans-sacral-foramen approach, to drain presacral abscess under CT guidance.

Methods:

A 47-year-old female who had lumbar laminectomy debridement for epidural abscess was diagnosed with residual presacral abscess. She was placed in prone position. One-step technique was applied. Intermittent CT scans were obtained during drainage catheter (8 Fr) advancement into the sacral posterior foramen. The stylet was withdrawn and an approximately 60° angle for catheter trajectory was used to best reach the sacral anterior foramen due to the inherent pelvic tilt. When the catheter tip reached the presacral abscess, the abscess cavity was aspirated with a syringe, pus was drained, and catheter was fixed to skin. Sensitive antibiotics were administered.

Results:

After 2 weeks MRI showed significant reduced abscess and the catheters were removed. On the 18th month’s follow-up, MRI showed intervertebral fusion at the lumbosacral segment.

Conclusion:

Trans-sacral-foramen approach is the shortest path to reach the presacral abscess. The approach is easier and safer than the others for patient with indication.