Image-Guided Transrectal Drainage of Pelvic Abscesses in Children

Abstract

Objective To describe our technique and share our experience with image-guided transrectal drainage (TRD) of pelvic abscesses in children.

Materials and Methods Retrospective review and analysis of indications for image-guided TRD and examination of procedural outcomes in pediatric patients with pelvic abscesses over 8 years.

Results A total of 69 patients (33 males and 36 females) with symptomatic pelvic abscesses underwent image-guided TRD. The median age and weight of the patients were 11.5 years (range, 3–18) and 46.8 kg (range, 15.1–118.0), respectively. The etiologies of the pelvic abscesses were perforated appendicitis (72.5%) and post-operative collections (27.5%). All patients presented with abdominal pain. Fever, emesis, and diarrhea were also common symptoms. The size of the pelvic abscesses ranged from 24.0 to 937.1 mL (median, 132.7). Technical success was achieved in 68 of 69 TRD procedures (98.6%). Clinical improvement was observed in all patients with technically successful TRD. The TRD catheter dwell time ranged from 0 to 10 days (median, 4.0). Most patients who underwent TRD for perforated appendicitis subsequently underwent elective appendectomy after the resolution of the pelvic abscess (84.0%). The median time from TRD to elective appendectomy was 2.8 months (range, 0.3–6.1). There were no procedure-related complications.

Conclusion Image-guided TRD is a safe and effective procedure with high technical and clinical success rates for the treatment of pelvic abscesses in children.

Keywords

pelvic abscess - appendicitis - image guided - interventional radiology

Publication History

Received: 01 August 2023

Accepted: 29 December 2023

Article published online:
06 February 2024

• References

• 1 Gervais DA, Hahn PF, O'Neill MJ, Mueller PR. CT-guided transgluteal drainage of deep pelvic abscesses in children: selective use as an alternative to transrectal drainage. AJR Am J Roentgenol 2000; 175 (05) 1393-1396
• 2 McDaniel JD, Warren MT, Pence JC, Ey EH. Ultrasound-guided transrectal drainage of deep pelvic abscesses in children: a modified and simplified technique. Pediatr Radiol 2015; 45 (03) 435-438
• 3 Mubarak WM, Sheikh N, John P, Temple MJ, Amaral JG, Connolly BL. Use of the transrectal ultrasound probe in aspiration and drainage in pediatric patients: a retrospective observational study. J Vasc Interv Radiol 2019; 30 (06) 908-914
• 4 Hogan MJ, Marshalleck FE, Sidhu MK. et al; Society of Interventional Radiology Standards of Practice Committee, Society for Pediatric Radiology Interventional Radiology Committee. Quality improvement guidelines for pediatric abscess and fluid drainage. Pediatr Radiol 2012; 42 (12) 1527-1535
• 5 Arani K, Nandalur K, Tucker CM, Bloom DA. Image-guided percutaneous drainage in the pediatric population: a primer for radiologists. J Clin Imaging Sci 2011; 1: 31-31
• 6 Koral K, Derinkuyu B, Gargan L, Lagomarsino EM, Murphy JT. Transrectal ultrasound and fluoroscopy-guided drainage of deep pelvic collections in children. J Pediatr Surg 2010; 45 (03) 513-518
• 7 Bonadio W, Langer M, Cueva J, Haaland A. Impact of percutaneous drainage on outcome of intra-abdominal infection associated with pediatric perforated appendicitis. Pediatr Infect Dis J 2017; 36 (10) 952-955
• 8 Bonadio W, Rebillot K, Ukwuoma O, Saracino C, Iskhakov A. Management of pediatric perforated appendicitis: comparing outcomes using early appendectomy versus solely medical management. Pediatr Infect Dis J 2017; 36 (10) 937-941
• 9 Huerta CT, Courel SC, Ramsey WA. et al. Nationwide management of perforated pediatric appendicitis: interval versus same-admission appendectomy. J Pediatr Surg 2023; 58 (04) 651-657
• 10 Vane DW, Fernandez N. Role of interval appendectomy in the management of complicated appendicitis in children. World J Surg 2006; 30 (01) 51-54
• 11 Butch RJ, Mueller PR, Ferrucci Jr JT. et al. Drainage of pelvic abscesses through the greater sciatic foramen. Radiology 1986; 158 (02) 487-491
• 12 Alexander AA, Eschelman DJ, Nazarian LN, Bonn J. Transrectal sonographically guided drainage of deep pelvic abscesses. AJR Am J Roentgenol 1994; 162 (05) 1227-1230 , discussion 1231–1232
• 13 Chung T, Hoffer FA, Lund DP. Transrectal drainage of deep pelvic abscesses in children using a combined transrectal sonographic and fluoroscopic guidance. Pediatr Radiol 1996; 26 (12) 874-878
• 14 Rao S, Hogan MJ. Trocar transrectal abscess drainage in children: a modified technique. Pediatr Radiol 2009; 39 (09) 982-984
• 15 Pereira JK, Chait PG, Miller SF. Deep pelvic abscesses in children: transrectal drainage under radiologic guidance. Radiology 1996; 198 (02) 393-396
• 16 Nosher JL, Needell GS, Amorosa JK, Krasna IH. Transrectal pelvic abscess drainage with sonographic guidance. AJR Am J Roentgenol 1986; 146 (05) 1047-1048