Chronic pelvic abscedation after completion proctectomy in an irradiated pelvis: another indication for ENDO-sponge treatment?

Six years after completion proctectomy, a patient presented with invalidating pain, fever and massive mucopurulent secretion through the perineal wound after completion proctectomy. CT-scan revealed a large presacral abscess and osteonecrosis of the sacrum. The patient consented to placement of an ENDO-sponge (B. Braun Medical B.V., Melsungen Germany). On day 4 granulation tissue covered the walls of the cavity and the amount of necrotic tissue and fibrin was reduced. The foam was changed every 4 days and treatment was continued for 20 days. On day 20, vacuum assisted closure therapy was stopped and the remnant cavity was further rinsed with saline. There was no more evacuation of mucus or pus. Three months later, the patient was symptom free and only a small perineal dimple remained. ENDO-sponge (B. Braun Medical B.V., Melsungen Germany) treatment is possible for presacral abscedation which is a well-known complication following abdominoperineal rectum amputation.