Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Infections
Abstract number: 25109
PRESACRAL ABSCESS: A NOVEL APPROACH TO DRAIN IT
Sumit BATRA 1 , Sumit ARORA 2 , Ramesh KUMAR 1
1 Vardhman Mahavir Medical College & Associated Safdarjang Hospital, New Delhi
(INDIA), 2 Maulana Azad Medical College & Associated Lok Nayak Hospital, New
Delhi (INDIA)
Osteo-articular tuberculosis in general and spinal tuberculosis in particular is major
health problem in technologically developing regions of world. Presacral region is one
of the uncommon yet difficult regions for drainage of abscess. Tubercular infection or
abscess generally responds well to antitubercular therapy. Surgical drainage is
indicated if it is not regressing on antitubercular therapy or if it is causing pressure
symptoms. It is difficult to approach the presacral region. Since many approaches
have been described, anterior transperitoneal approach is most commonly used.
Others being presacral route, perineal route or precoccygeal route. We are
presenting case series of 12 such cases of tubercular etiology presented to us with
cauda equina syndrome. All of them had complete neurological recovery within 3
days to 3 weeks (mean: 7.8 days) of performing abscess drainage by transpedicular
approach. Transpedicular approach has been reported in literature sparsely.
Transpedicular approach to presacral region is a safer option as compared to other
approaches to reach this region. It simultaneously allows decompression of cauda
equina nerve roots by laminotomy without changing position of the patient in the
theatre. The key to success with this approach is early diagnosis and early treatment.
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