Civilian Extraperitoneal Rectal Gunshot Wounds: Surgical Management Made Simpler

Background Rectal injuries are associated with significant morbidity and mortality. Controversy persists regarding routine presacral drainage, distal rectal washout (DRW), and primary repair of extraperitoneal rectal injuries. This retrospective review was performed to determine the outcome of rectal injuries in an urban trauma center with a high incidence of penetrating trauma where a non-aggressive surgical approach to these injuries is practiced. Methods The records of all patients with a full-thickness penetrating rectal injury admitted to the Trauma Center at Groote Schuur Hospital over a 4-year period were reviewed. These were reviewed for demographics, injury mechanism and perioperative management, anatomical site of the rectal injury, associated intra-abdominal injuries and their management. Infectious complications and mortality were noted. Intraperitoneal rectal injuries were primarily repaired, with or without fecal diversion. Extraperitoneal rectal injuries were generally left untouched and a diverting colostomy was done. Presacral drainage and DRW were not routinely performed. Results Ninety-two patients with 118 rectal injuries [intraperitoneal (7), extraperitoneal (59), combined (26)] were identified. Only two extraperitoneal rectal injuries were repaired. None had presacral drainage. Eighty-six sigmoid loop colostomies were done. Two (2.2%) fistula, one rectocutaneous, and one rectovesical, were recorded. There were nine (9.9%) infectious complications: surgical site infection (4), buttock abscess (1), buttock necrosis (1), pubic ramus osteitis (1), septic arthritis (2). No perirectal sepsis occurred. Conclusions Extraperitoneal rectal injuries due to low-velocity trauma can be safely managed by fecal diversion alone.     

Diagnostic and therapeutic aspects of rectal trauma. Blunt versus penetrating

In the last 6 years, nine patients with blunt and 16 with penetrating rectal injuries were treated at University Hospital, Jacksonville, Florida. Blunt trauma was caused by vehicular accidents in seven patients and crush injuries in two. Penetrating rectal trauma was due to gunshot wounds in ten patients and foreign body insertion in six. All patients with blunt injury had bright red rectal bleeding, which led to diagnostic sigmoidoscopy. Rectal injury was identified at sigmoidoscopy in 12 patients who had penetrating wounds and at laparotomy in four patients. Thirteen patients who had penetrating rectal trauma had injury to only the rectum or to one additional organ. In contrast, all patients who had blunt rectal trauma had at least three associated injuries. In the penetrating group, 13 patients were treated by colostomy and mucus fistula; three patients with mucosal injury were managed nonoperatively. The only death occurred in a patient whose rectal injury was initially missed. Patients who had blunt rectal trauma were managed with colostomy and mucus fistula. Three patients died postoperatively, two of pelvic bleeding and one of head injury. Hemodynamic stabilization, colostomy and mucus fistula, presacral drainage, and rectal washout constitute proper treatment of patients with blunt or penetrating rectal trauma. Because of the greater number and severity of associated injuries, morbidity and mortality are higher after blunt rectal trauma.     

Management options in penetrating rectal injuries.

A retrospective analysis of 54 patients (1976-1989) with penetrating rectal injuries was carried out to evaluate the options in management. The diagnosis was made on proctosigmoidoscopy in 39 patients and at laparotomy in 15. Three patients died within 24 hours from extensive associated trauma (Abdominal Trauma Index [ATI] 39.2). In the remaining 51 patients, rectal wound repair was performed in seven patients, four without proximal colostomy (mean ATI 16.5) and three with colostomy (mean ATI 24.8) without complications. Colostomy and presacral drainage with or without repair were employed in 43 patients. Twenty-one of these patients had rectal washout in addition. The other 22 patients did not have this procedure. The incidence of pelvic abscess in these two groups, who had comparable mean ATI, was identical (4.7% and 4.5%, respectively). One other patient with an extraperitoneal rectal injury had a colostomy alone without presacral drainage and subsequently developed pelvic abscess. The overall incidence of abscess was three of 51 patients or 5.8%. There were no late deaths from sepsis. It is concluded that colostomy (loop or end) and presacral drainage are the most important components of rectal injury management. Small and isolated rectal or rectosigmoid perforations may be repaired primarily without fecal diversion. The value of distal rectal irrigation remains to be proven, but it may be indicated in high-energy injuries of the rectum.     

Management of rectal injuries. Dogma versus practice

The current treatment of civilian rectal injuries stems from military practice. Five principles have evolved: 1) complete fecal diversion, 2) debridement and closure, 3) rectal stump irrigation, 4) presacral drainage, and 5) broad spectrum antibiotics. To assess our practice results, the records of 52 consecutive patients with rectal injury seen at Detroit Receiving Hospital from 1980-88 were reviewed. Etiologies were gunshot (40), shotgun (9), anal assault (2), and stab (1). There were no blunt injuries and no deaths. Treatment consisted of celiotomy (52), diverting colostomy (51), presacral drains (35), rectal stump irrigation (26), and primary closure (1). Broad spectrum antibiotics were administered in all patients. Despite lack of universal application of the "standard" principles, only five patients had postoperative complications and none were related to the rectal injury. Our results demonstrate that a single approach may not be justified, as excellent outcome was achieved with low morbidity and no mortality despite selective management. The universal application of colostomy, repair, irrigation, drainage, and antibiotics cannot be supported.     

Colostomy and drainage for civilian rectal injuries: is that all?

One hundred consecutive patients with injuries to the extraperitoneal rectum were treated over a ten-year period at an urban trauma center. The mechanisms of injury included firearms in 82 patients, stab wounds in 3 patients, a variety of other penetrating injuries in 10 patients, and in 5 patients the injuries resulted from blunt trauma. Treatment of the rectal injury was determined by the bias of the operating surgeon, the condition of the patient, and the magnitude of the rectal injury. Proximal loop colostomies were performed in 44 patients, diverting colostomies in 51 patients, Hartmann's procedure in 4 patients, and an abdominoperineal resection in 1 patient. Extraperitoneal rectal perforations were closed in 21 patients and the rectum was irrigated free of feces in 46 patients. Transperineal, presacral drainage was used in 93 patients. Infectious complications potentially related to the management of the rectal wound occurred in 11 patients (11%) and included abdominal or pelvic abscesses (4 patients), wound infections (6 patients), rectocutaneous fistulas (3 patients), and missile tract infections (2 patients). Four patients (4%) died as a result of their injuries. Of the therapeutic options available, statistical analysis revealed that only the failure to drain the presacral space increased the likelihood of infectious complications (p = 0.03); however, as it could not be determined with certainty that the use of, or failure to use, any particular therapeutic option had an effect on the risk of death. It is concluded that colostomy and drainage are the foundations of the successful treatment of civilian injuries to the extraperitoneal rectum. The use of adjuncts such as diverting colostomies, repair of the rectal wound, and irrigation of the rectum has little effect on mortality and morbidity.     

Immediate postoperative complications of combined penetrating rectal and bladder injuries

BACKGROUND: Combined penetrating trauma involving the rectum and bladder has been associated with increased postoperative morbidity. Specific complications resulting from these injuries include colovesical fistula, urinoma, and abscess formation. METHODS: A retrospective review of Temple University Hospital trauma database was performed. Patients were categorized by having an isolated rectal (n = 29), isolated bladder (n = 16), or combined injury (n = 24). Records were reviewed for sex, age, site of injury, location of rectal and bladder injuries, operative intervention, fistula formation, urinoma formation, abscess formation, time to urinary catheter removal, length of intensive care unit stay, and length of hospital stay. RESULTS: Patient sex and age did not differ significantly between groups, nor was there a significant difference in location of rectal injury between groups. Presacral drainage was utilized in all patients with extraperitoneal injuries. Fecal diversion was performed in all patients, except two with intraperitoneal rectal injuries. Omental flap interposition between rectal and bladder injuries was utilized in one patient. No significant difference was noted in immediate postoperative complications between groups including fistula, urinoma, and abscess formation. However, all cases of colovesical fistula (n = 2) and urinoma (n = 2) formation were noted in those patients with rectal and posterior bladder injuries. CONCLUSIONS: Combined rectal and bladder injuries were not associated with an increase in immediate postoperative complications compared with isolated rectal and bladder injuries. However, postoperative fistula and urinoma formation occurred only in patients with a combined rectal and posterior bladder injury. Consequently, these patients may benefit from omental flap interposition between injuries to decrease fistula and urinoma formation.     

Diagnostic laparoscopy and diverting sigmoid loop colostomy in the management of civilian extraperitoneal rectal gunshot injuries

BACKGROUND: This prospective study reviews the management of isolated civilian extraperitoneal rectal gunshot injuries using a protocol of diagnostic laparoscopy and abdominal wall trephine diverting loop colostomy, without laparotomy, distal rectal washout and presacral drainage. METHODS: Patients admitted to the trauma unit at Groote Schuur Hospital between January 2000 and December 2002 with a rectal injury were evaluated. A rectal injury was confirmed by digital rectal examination and proctosigmoidoscopy. Missile peritoneal violation was excluded by diagnostic laparoscopy. Normal laparoscopy was followed by creation of a diverting sigmoid loop colostomy through an abdominal wall trephine, without a laparotomy. No distal rectal washout or presacral drainage was performed. RESULTS: Of the 104 patients admitted with 106 rectal injuries, 20 (19.2 per cent) qualified for inclusion in the study. All had sustained low-velocity gunshot injuries of which 18 exhibited a transpelvic trajectory. Diagnostic laparoscopy was normal and a trephine diverting loop sigmoid colostomy was performed in all 20 patients. No pelvic sepsis occurred. Two patients developed rectocutaneous fistulas, both of which resolved without surgical treatment. Nineteen stomas have since been closed. CONCLUSION: Low-velocity gunshot injuries isolated to the extraperitoneal rectum can be managed safely by laparoscopic exclusion of intraperitoneal missile penetration and diverting sigmoid loop colostomy, without laparotomy, distal rectal washout or presacral drainage     

Early evacuation of clotted hemothorax

Thoracotomy is infrequently required for penetrating or blunt thoracic trauma. Complications of thoracic trauma, such as clotted hemothorax and empyema, significantly increase morbidity, mortality, and length of hospitalization. Among approximately 9,000 patients with blunt or penetrating thoracic trauma seen during a recent eleven year period, 33 per cent (3,000 patients) presented with hemothorax or pneumohemothorax. The average length of hospitalization in the patient with uncomplicated thoracic trauma was less than six days. Among the 3,000 patients with hemothorax or pneumohemothorax, 2,600 (85 per cent) were treated with a drainage procedure. Among this group, clotted hemothorax or posttraumatic empyema developed in 85 (3.3 per cent). Among ten patients undergoing evacuation of a clotted hemothorax within five days of admission, there was zero mortality and an average hospital stay of ten days. Forty-one patients undergoing decortication more than five days after injury had a 2.4 per cent mortality, with the average period of hospitalization being twenty-five days. Thirty-four patients requiring decortication and drainage of empyema had a 12 per cent mortality and an average hospital stay of forty-one days. Among those patients in whom empyema developed, the most frequently associated injuries were enteric. These complications occurred due to inadequate evacuation of the original hemothorax, nonfunctioning tube thoracostomy, physician delay in recognition of the pathologic process, and bacterial contamination of the hemothorax. When complications secondary to tube thoracostomy dysfunction occurred, early operative evacuation of clotted hemothorax decreased the mortality, morbidity, and hospital stay and prevented the development of empyema.     

Operative Management of Civilian Rectal Gunshot Wounds: Simpler Is Better

Extraperitoneal rectal gunshot wounds have been managed with a variety of methods from simple diverting colostomy to combinations of rectal repair, proximal diversion, transperitoneal or presacral drainage, and distal bowel irrigation techniques. Treatment methodology is chosen based on anecdotal experience, and there is no clear evidence that any technique is superior to the others. The objective of this study was to compare 3 methods of managing civilian extraperitoneal gunshot wounds. Retrospective analysis of 30 consecutive patients with extraperitoneal rectal gunshot wounds was undertaken. Patients were treated with 1 of these 3 techniques: (1) simple diverting colostomy without rectal repair (group A, 12 patients); (2) diverting colostomy and rectal repair (group B, 12 patients); and (3) diverting colostomy and presacral drainage without repair (group C, 6 patients). Injury, hospital course, and outcome data were compared. The 3 groups were similar in age, injury severity, admission hemodynamics, preoperative and intraoperative time, blood loss, fecal contamination, and associated injuries. The overall incidence of complications was 27% (8/27): 25% (3/12) in group A, 33% (4/12) in group B, and 17% (1/6) in group C (p= NS). Complications directly associated with the rectal injury were found in 2 cases (7%): 1 group A patient developed a vesicorectal fistula and 1 group B patient developed a rectocutaneous fistula. For 10 patients with both rectal and bladder injuries, the complication rates for groups A, B, and C were 50%, 20%, and 0%, respectively (p= NS). No patient died. In conclusion, diverting colostomy without rectal repair or drainage appears to be safe for the management of most civilian retroperitoneal rectal gunshot wounds. Additional surgical maneuvers may be required for combined rectal and urinary trauma or other complex rectal injuries. Sound surgical principles, tailored to the individual case, should overrule any unproven dogmas.     

Conservative surgery for trauma to the pancreatic head: is it safe?

The results of conservative operative management (involving no pancreatic resection) for 13 patients presenting with trauma to the pancreatic head over a period of 10 years were reviewed. Seven patients with injury of the pancreatic head without duodenal or ductal involvement made an uneventful recovery after simple drainage. The average hospital stay was 6.7 days. The remaining six patients with either duodenal (four patients) and/or ductal involvement (five patients) developed 22 major complications. One of these patients died of multiple organ failure, and the rest had an average hospital stay of 43 days. Injury of the vena cava was noted in five patients, but was not significantly associated with additional morbidity or mortality. Although simple drainage of pancreatic head injuries is associated with a low mortality, there is an unacceptably high incidence of complications if either the duodenum or pancreatic duct is involved. The authors recommend that simple drainage be restricted to patients in whom neither of these structures is injured.     

Rectal trauma: A retrospective analysis and guidelines for therapy

Twenty patients seen at Boston City Hospital required general or spinal anesthesia for rectal injuries, and 17 required laparotomy. Findings on sigmoidoscopy were falsely negative in 4 of 13 patients examined. Diagnosis was delayed in two patients. Associated injuries occurred in 55 percent, with the lower genitourinary tract being the area most frequently injured. Complications occurred in eight patients (40 percent). Abscess formation and bacteremia were the most common, but iatrogenic complications occurred in four patients. Pulmonary embolism occurred in two patients and was suspected in a third patient. Routine treatment included diverting colostomy with distal irrigation and adequate drainage. Repair of the injury was performed when possible. Two of the 20 patients (10 percent) died, one after a prolonged septic course and one from recurrent pulmonary embolism. Rectal trauma continues to be a challenging injury.     

Prospective evaluation of combined suprapubic and urethral catheterization to urethral drainage alone for intraperitoneal bladder injuries

BACKGROUND: The role of suprapubic catheterization after repair of intraperitoneal bladder injury is controversial and has been found to be superfluous in retrospective studies. We sought to evaluate bladder drainage prospectively. METHODS: Patients were prospectively enrolled and were assigned to suprapubic catheter drain after bladder repair or urethral catheter alone determined by the unit admitting the patient. Factors that were evaluated were associated injuries, hospital stay, duration of catheterization, and catheter-related complications. RESULTS: There were 42 patients: there were 39 male patients, and the mean age was 29.6 years. The patients were matched for age and associated injuries. The morbidity (p = 0.004) and hospital stay (p = 0.028) were significantly higher in the suprapubic drainage group. CONCLUSION: Urethral catheterization is adequate to effect bladder drainage after intraperitoneal bladder injury. In addition, it is associated with a shorter hospital stay and lower morbidity.     

Mesenteric injury after blunt abdominal trauma.

OBJECTIVE: To present our experience of mesenteric injuries after blunt abdominal trauma. DESIGN: Retrospective study. SETTING: University hospital, Greece. SUBJECTS: 31 patients with mesenteric injuries out of 333 who required operations for blunt abdominal trauma between March 1978 and March 1998. 21 were diagnosed within 6 hours (median 160 min, early group) and in 10 the diagnosis was delayed (median 21 hours, range 15 hours-7 days, delayed group). INTERVENTIONS: Emergency laparotomy. MAIN OUTCOME MEASURES: Mortality, morbidity, and hospital stay. RESULTS: There were no deaths. The diagnosis was confirmed by diagnostic peritoneal lavage in 17/21 patients in the early group whereas 7/10 in the delayed group were diagnosed by clinical examination alone. Most of the injuries (n = 23) were caused by road traffic accidents. 30 patients had injured the small bowel mesentery and 4 the large bowel mesentery. 25 of the 31 patients had associated injuries. There were no complications in the early group, compared with 6 wound infections and 1 case of small bowel obstruction in the delayed group (p < 0.0001). Median hospital stay in the early group was 11 days (range 3-24) compared with 23 days (range 10-61) in the delayed group (p = 0.004). CONCLUSION: Because delay in diagnosis is significantly associated with morbidity and duration of hospital stay we recommend that all patients admitted with blunt abdominal trauma should have a diagnostic peritoneal lavage as soon as possible     

Penetrating rectal trauma: management by anatomic distinction improves outcome

BACKGROUND: Controversy persists regarding the optimal management of penetrating rectal injuries, specifically with respect to the routine application of diversion and presacral drainage. Our previous experience suggested that management decisions based on precise anatomic characterization of injury relative to retroperitoneal involvement might improve outcome. A clinical pathway was developed and implemented. Patients managed by the pathway (PATH) were compared with the previous study (PREV, n=58) to determine the impact of the clinical pathway on outcome. METHODS: Consecutive patients with full-thickness penetrating rectal injury subsequent to the development of the pathway were evaluated. Intraperitoneal rectal injuries (IP) were treated with primary repair. Injuries to the proximal two-thirds and accessible distal one-third of the extraperitoneal rectum (EP) were treated with repair and selective fecal diversion. Inaccessible distal EP injuries were treated with diversion and presacral drainage. Infectious complications (wound infection, bacteremia, intraabdominal abscess, retroperitoneal abscess) were compared between the PATH and PREV groups. RESULTS: In all, 54 patients were identified. Demographics, injury severity, and preventive antibiotics (24-hour) were similar between groups. Overall infectious complication rate was 13% in the PATH group versus 31% in the PREV group (p<0.05). There was a zero incidence of retrorectal abscess in the PATH group versus 11% of the total complications in the PREV group. CONCLUSIONS: Implementation of the pathway resulted in a significant decrease in infectious morbidity. Management by anatomic distinction allows for omission of colostomy in most IP injuries and select EP injuries, while diminishing the risk of retrorectal abscess in EP injuries with the judicious application of presacral drainage.     

Reevaluation of early evacuation of clotted hemothorax

During an 181/2 year period, we encountered 14,300 patients with blunt or penetrating thoracic or thoracicoabdominal trauma. In 155 patients, residual clotted hemothorax or empyema developed later. Thirty-nine patients underwent early evacuation of clotted hemothorax with no mortality and an average hospital stay of only 10 days. When progression to empyema occurred, the mortality rate increased to 9.4 percent and the average hospital stay to 37.9 days. The most common related event in the development of empyema was concurrent injury to intraabdominal organs and the inevitable bacterial contamination of the thorax. In a small number of patients, tube thoracostomy drainage is inadequate and results in residual clotted hemothorax. Despite recent pleas for conservative, expectant management, it is our experience that early evacuation of clotted hemothorax is not only cost-effective, it is also associated with lower morbidity, lower mortality, and reduces the chance of development of empyema.     

骶前引流方式对直肠癌低位前切除术后吻合口漏愈合的影响

目的比较经会阴和经腹壁两种不同的骶前引流方式对直肠癌低位前切除术后吻合口漏愈合的影响。方法总结2010年1月至2015年12月间45例直肠癌低位前切除术后吻合口漏的临床资料。结果经会阴和经腹壁两种引流方式在病人年龄、性别、是否接受新辅助放化疗、平均手术时间、p TNM分期、术后发生漏的确定时间、初次手术后平均住院时间等方面差异均无统计学意义(P0.05)。但经会阴引流组的保护性造口率(16.7%)、腹膜炎发生率(8.3%)及再次手术率(16.7%)均明显低于经腹壁引流组(分别为75.8%、39.4%、93.9%,P0.05)。结论经会阴骶前引流可降低低位直肠吻合口漏的相关并发症,有助于吻合口漏的愈合。     

Pediatric anorectal impalement with bladder rupture: case report and review of the literature

Rectal impalement involves foreign body trauma to the anus or rectum resulting in intra- or extraperitoneal rupture. Evaluation of suspected rectal impalement injury involves careful history and physical examination. Ruling out rectal perforation in patients with reported impalement is critical even if there is no evidence of trauma to the perineum. There are few reports on pediatric impalement and only 1 reported case of pediatric rectal impalement with bladder rupture. We report a rectal impalement with extraperitoneal bladder injury in a 12-year-old boy and review the literature on treatment of these injuries.     

Risk and benefit of intravenous contrast in trauma patients with an elevated serum creatinine

OBJECTIVE: Assess if the benefits outweigh the risks of intravenous (iv) contrast in trauma patients who present with an elevated serum creatinine (Cr). BACKGROUND: Radiologic investigations with iv contrast are often used in trauma patients to rapidly assess for life threatening injuries. However, contrast nephropathy (CNP) is associated with increased morbidity and mortality. This poses a dilemma for the physician who must weigh the risks and benefits of proceeding with iv contrast versus the risks of missed injuries/delayed diagnosis. METHODS: A 2 year (2002-2003) retrospective chart review of all trauma patients presenting with an elevated Cr(> or =1.3 mg/dL or > or =115 micromol/L). Results are mean +/- sd (p < 0.05 significant). RESULTS: Ninety-five patients (age 51 +/- 23 years; ISS 31.7 +/- 15.6; hospital stay 29 +/- 32 days; mortality 9%) presented with a Cr > or = 1.3 mg/dL (31 with Cr > or =1.7; 3 dialysis dependent). Fifty-six (59%) were given iv contrast (C+), of which only 2 (3%) had a transient rise of 25% in Cr within 48 hours versus 6 (16%) patients not exposed to contrast (C-). No C+ patient developed CNP requiring longterm dialysis. Of the 56 undergoing C+ tests, 16 had injuries requiring urgent intervention identified; 16 had injuries that were managed nonoperatively, and 24 had serious injuries ruled out. Of the 39 C- patients, 9 had indeterminate CT's; 2 had missed injuries; and 2 had no intraabdominal injuries found at celiotomy. CONCLUSION: This study suggests the benefits may outweight the risks for proceeding prn with iv contrast in trauma patients with an elevated creatinine. A larger study is needed to confirm these findings.     

Current indications and results of VATS in the evaluation and management of hemodynamically stable thoracic injuries

Objective: Thoracic injuries are among the most severe forms of trauma and also a leading cause of morbidity and mortality. Video Assisted Thoracic Surgery (VATS) has recently provided an alternative method to simultaneously diagnose and manage patients sustaining chest injuries. We analyze our experience with VATS in the setting of thoracic trauma detailing indications for exploration, procedures performed and results of surgery. Methods: A 6-year single institution review of patients undergoing VATS due to injuries sustained from both blunt and penetrating chest trauma at a Level I trauma center and university teaching hospital. Comparisons were made between groups of blunt and penetrating trauma as to Injury Severity Score (ISS), presence of extra-thoracic injuries, initial thoracostomy drainage and length of postoperative stay. Results: VATS was successfully performed in 19 consecutive patients without conversion to thoracotomy. Indications for exploration included acute hemorrhage, retained hemothorax, suspected diaphragmatic injuries (DI), suspected cardiac injury, intra-thoracic foreign body, persistent airleak and chronic empyema. Procedures performed consisted of evacuation of retained hemothorax, hemostasis of intra-thoracic bleeders, repair of DI, wedge lung resections and decortication. Mean postoperative length of stay was 5.86 days. There were no morbidities. One patient with severe intra-abdominal injuries expired on the first postoperative day. Conclusion: In hemodynamically stable patients with thoracic injuries, VATS provides an accurate assessment of intra-thoracic organ injury and can be utilized to definitively and effectively manage injuries sustained as a result of blunt or penetrating thoracic trauma. VATS should be used with caution in patients sustaining severe and life threatening intra-abdominal injuries.     

骶尾旁入路治疗成人骶前囊肿

目的探讨成人骶前囊肿的临床特点及经骶尾旁入路治疗效果。方法回顾性分析2000年至2004年之间诊治的23例成人骶前囊肿的临床特点及治疗方法并结合文献分析。结果23例均表现为不同程度的骶尾或会阴部疼痛伴肛门坠胀,直肠腔内B超和MRI检查准确率100%。手术采用经骶尾旁入路,21例囊肿完全切除,2例部分切除。无直肠损伤及相关手术并发症。结论骶前囊肿常无典型临床表现,直肠腔内B超可作为初步诊断的首选检查。经骶尾旁入路可以治疗大多数骶前囊肿,手术创伤小,出血少,明显降低了相关并发症。