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Session: ePoster: Pelvic Floor 1 (Sun8)

EP334 - Incidental Postoperative Presacral Fluid Collections Following Posterior Sutured Rectopexy: Abscess or Innocent Bystander?

Sunday, May 11, 2025
8:38 AM – 8:43 AM PT
Location: Monitor 8. Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • JL

    Jose D. Llaque Salazar, MD

    Resident Physician
    Univeristy of Colorado School of Medicine
    Denver, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Laura C. Perez Arteaga, MD

    Resident Phycisian
    University of Colorado School of Medicine
    Denver, CO, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • IZ

    Ioannis A. Ziogas, MD, MPH

    Resident Phycisian
    University of Colorado School of Medicine
    Denver, Colorado, United States

    Disclosure information not submitted.

  • EB

    Elisa Birnbaum, MD

    Professor of Surgery
    University of Colorado School of Medicine
    university of colorado
    Denver, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • MM

    Michael S. McNevin, MD

    Associate Professor of Surgery
    University of Colorado School of Medicine
    Denver, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • AM

    Amber Moyer, MD

    Assistant Professor of Surgery
    University of Colorado School of Medicine
    Denver, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Jose D. Llaque Salazar, MD: This individual has no financial relationships with ineligible companies.
Laura C. Perez Arteaga, MD: This individual has no financial relationships with ineligible companies.
Elisa Birnbaum, MD: This individual has no financial relationships with ineligible companies.
Michael S. McNevin, MD: This individual has no financial relationships with ineligible companies.
Amber Moyer, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Posterior Sutured Rectopexy (PSR) has long been the routine approach to isolated rectal procidentia or as part of a multidisciplinary approach to multi-compartment pelvic organ prolapse repair. Presacral fluid collections after PSR are often interpreted radiologically as abscesses and present difficult management decisions. The aim of this study was to evaluate the incidence of postoperative presacral fluid collections after PSR and the need for intervention.

Methods/Interventions: All consecutive adult patients with rectal and pelvic organ prolapse who underwent open or robotic rectopexy at a quaternary academic institution from June 2022-July 2024 were assessed. Patients who underwent cross sectional imaging for any indication within 30 days of their rectopexy were included. Presacral fluid collection was defined as any circumscribed fluid collected in the presacral space.

Results/Outcomes: Among 336 patients who underwent rectopexy, 294 underwent PSR (255 open and 39 robotic) and 42 robotic ventral mesh rectopexy (VMR). 31 postoperative patients from PSR underwent cross sectional imaging of the abdomen and pelvis within 30 days after their procedure. The most common indications for imaging included abdominal pain, fever, nausea, vomiting, constipation, concern for bleeding. The rate of fluid present in the presacral space was 61.2% (n=19/31), 42.1% (n=8/19) had a well circumscribed rim enhancing fluid collection, 31.6% (n=6/19) had free fluid and air, and 26.3% (n=5/19) had findings consistent with hematoma. No drainage procedures were required. Of the eight patients with a rim-enhancing fluid collection, the median white blood cell count was 8.9 × 109/L and none exhibited hemodynamic instability. Only two of the eight patients with a rim-enhancing fluid collection were prescribed antibiotics. There was no difference in the rate of presacral fluid collection between open and robotic approaches

Conclusion/Discussion: In this single-center retrospective cohort study, the rate of presacral fluid after PSR in patients that underwent imaging within 30 days was 61%, almost half interpreted as abscesses. There were no interventions required and only 11% were treated with antibiotics. Postoperative fluid collections after PSR is a common finding on imaging but is of limited clinical significance and does not necessitate treatment in the absence of systemic symptoms