Download PDF
Semin intervent Radiol 2012; 29(04): 286-294
DOI: 10.1055/s-0032-1330062
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Percutaneous Drainage of Abdominal and Pelvic Abscesses in Children

Colin Brown
1   Department of Radiology, University of Chicago, Chicago, Illinois
,
Lisa Kang
1   Department of Radiology, University of Chicago, Chicago, Illinois
,
Stanley T. Kim
2   Department of Radiology, Northwestern University, Evanston, Illinois
› Author Affiliations
Further Information

Publication History

Publication Date:
11 December 2012 (online)

Also available at
    Permissions and Reprints

Abstract

It has only been in the last several decades that abscesses within deep compartments, particularly within the abdomen and pelvis, have become safely accessible with imaging guidance. Since that time, percutaneous abscess drainage has become the standard of care in children. We review the clinical features, diagnosis, and image-guided management of abdominal and pelvic abscesses in children.

Keywords

interventional radiology - pediatric - abscess drain - appendicitis - percutaneous therapy
 

  • References

  • 1 Briddon III CK. Surgical observations in the treatment of the diseases and accidents of the Liver. Ann Surg 1885; 2 (7) 51-61
    CrossrefPubMedGoogle Scholar
  • 2 Towbin RB. Pediatric interventional procedures in the 1980s: a period of development, growth, and acceptance. Radiology 1989; 170 (3 Pt 2) 1081-1090
    PubMedGoogle Scholar
  • 3 Mueller PR. The evolution of image-guided percutaneous abscess drainage: a short history. Semin Intervent Radiol 2003; 20 (3) 171-176
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Hogan MJ. Appendiceal abscess drainage. Tech Vasc Interv Radiol 2003; 6 (4) 205-214
    CrossrefPubMedGoogle Scholar
  • 5 Whyte C, Levin T, Harris BH. Early decisions in perforated appendicitis in children: lessons from a study of nonoperative management. J Pediatr Surg 2008; 43 (8) 1459-1463
    CrossrefPubMedGoogle Scholar
  • 6 McNeeley MF, Vo NJ, Prabhu SJ, Vergnani J, Shaw DW. Percutaneous drainage of intra-abdominal abscess in children with perforated appendicitis. Pediatr Radiol 2012; 42 (7) 805-812
    CrossrefPubMedGoogle Scholar
  • 7 McCann JW, Maroo S, Wales P , et al. Image-guided drainage of multiple intraabdominal abscesses in children with perforated appendicitis: an alternative to laparotomy. Pediatr Radiol 2008; 38 (6) 661-668
    CrossrefPubMedGoogle Scholar
  • 8 Rosen MP, Ding A, Blake MA , et al. ACR Appropriateness Criteria® right lower quadrant pain—suspected appendicitis. J Am Coll Radiol 2011; 8 (11) 749-755
    CrossrefPubMedGoogle Scholar
  • 9 Krishnamoorthi R, Ramarajan N, Wang NE , et al. Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA. Radiology 2011; 259 (1) 231-239
    CrossrefPubMedGoogle Scholar
  • 10 Jamieson DH, Chait PG, Filler R. Interventional drainage of appendiceal abscesses in children. AJR Am J Roentgenol 1997; 169 (6) 1619-1622
    CrossrefPubMedGoogle Scholar
  • 11 Levin T, Whyte C, Borzykowski R, Han B, Blitman N, Harris B. Nonoperative management of perforated appendicitis in children: can CT predict outcome?. Pediatr Radiol 2007; 37 (3) 251-255
    CrossrefPubMedGoogle Scholar
  • 12 Rypens F, Dubois J, Garel L, Deslandres C, Saint-Vil D. Percutaneous drainage of abdominal abscesses in pediatric Crohn's disease. AJR Am J Roentgenol 2007; 188 (2) 579-585
    CrossrefPubMedGoogle Scholar
  • 13 Gervais DA, Hahn PF, O'Neill MJ, Mueller PR. Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years. Radiology 2002; 222 (3) 645-651
    CrossrefPubMedGoogle Scholar
  • 14 Yamaguchi A, Matsui T, Sakurai T , et al. The clinical characteristics and outcome of intraabdominal abscess in Crohn's disease. J Gastroenterol 2004; 39 (5) 441-448
    CrossrefPubMedGoogle Scholar
  • 15 Safrit HD, Mauro MA, Jaques PF. Percutaneous abscess drainage in Crohn's disease. AJR Am J Roentgenol 1987; 148 (5) 859-862
    CrossrefPubMedGoogle Scholar
  • 16 Huprich JE, Rosen MP, Fidler JL , et al. ACR Appropriateness Criteria on Crohn's disease. J Am Coll Radiol 2010; 7 (2) 94-102
    CrossrefPubMedGoogle Scholar
  • 17 Sahai A, Bélair M, Gianfelice D, Coté S, Gratton J, Lahaie R. Percutaneous drainage of intra-abdominal abscesses in Crohn's disease: short and long-term outcome. Am J Gastroenterol 1997; 92 (2) 275-278
    PubMedGoogle Scholar
  • 18 Muorah M, Hinds R, Verma A , et al. Liver abscesses in children: a single center experience in the developed world. J Pediatr Gastroenterol Nutr 2006; 42 (2) 201-206
    CrossrefPubMedGoogle Scholar
  • 19 Simeunovic E, Arnold M, Sidler D, Moore SW. Liver abscess in neonates. Pediatr Surg Int 2009; 25 (2) 153-156
    CrossrefPubMedGoogle Scholar
  • 20 Lublin M, Bartlett DL, Danforth DN , et al. Hepatic abscess in patients with chronic granulomatous disease. Ann Surg 2002; 235 (3) 383-391
    CrossrefPubMedGoogle Scholar
  • 21 Lee SH, Tomlinson C, Temple M, Amaral J, Connolly BL. Imaging-guided percutaneous needle aspiration or catheter drainage of neonatal liver abscesses: 14-year experience. AJR Am J Roentgenol 2008; 190 (3) 616-622
    CrossrefPubMedGoogle Scholar
  • 22 Rao S, Solaymani-Mohammadi S, Petri Jr WA, Parker SK. Hepatic amebiasis: a reminder of the complications. Curr Opin Pediatr 2009; 21 (1) 145-149
    CrossrefPubMedGoogle Scholar
  • 23 Gyorffy EJ, Frey CF, Silva Jr J, McGahan J. Pyogenic liver abscess. Diagnostic and therapeutic strategies. Ann Surg 1987; 206 (6) 699-705
    CrossrefPubMedGoogle Scholar
  • 24 Liu GJ, Lu MD, Xie XY , et al. Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions. J Ultrasound Med 2008; 27 (4) 657-666
    CrossrefPubMedGoogle Scholar
  • 25 Halvorsen Jr RA, Foster Jr WL, Wilkinson Jr RH, Silverman PM, Thompson WM. Hepatic abscess: sensitivity of imaging tests and clinical findings. Gastrointest Radiol 1988; 13 (2) 135-141
    CrossrefPubMedGoogle Scholar
  • 26 Liu CH, Gervais DA, Hahn PF, Arellano RS, Uppot RN, Mueller PR. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome?. J Vasc Interv Radiol 2009; 20 (8) 1059-1065
    CrossrefPubMedGoogle Scholar
  • 27 Rajak CL, Gupta S, Jain S, Chawla Y, Gulati M, Suri S. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. AJR Am J Roentgenol 1998; 170 (4) 1035-1039
    CrossrefPubMedGoogle Scholar
  • 28 Tan YM, Chung AY, Chow PK , et al. An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm. Ann Surg 2005; 241 (3) 485-490
    CrossrefPubMedGoogle Scholar
  • 29 Yu SC, Ho SS, Lau WY , et al. Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Hepatology 2004; 39 (4) 932-938
    CrossrefPubMedGoogle Scholar
  • 30 Barakate MS, Stephen MS, Waugh RC , et al. Pyogenic liver abscess: a review of 10 years' experience in management. Aust N Z J Surg 1999; 69 (3) 205-209
    CrossrefPubMedGoogle Scholar
  • 31 Hanna RM, Dahniya MH, Badr SS, El-Betagy A. Percutaneous catheter drainage in drug-resistant amoebic liver abscess. Trop Med Int Health 2000; 5 (8) 578-581
    CrossrefPubMedGoogle Scholar
  • 32 Ralls PW, Barnes PF, Johnson MB, De Cock KM, Radin DR, Halls J. Medical treatment of hepatic amebic abscess: rare need for percutaneous drainage. Radiology 1987; 165 (3) 805-807
    PubMedGoogle Scholar
  • 33 Blessmann J, Binh HD, Hung DM, Tannich E, Burchard G. Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study. Trop Med Int Health 2003; 8 (11) 1030-1034
    CrossrefPubMedGoogle Scholar
  • 34 Angel C, Shu T, Green J, Orihuela E, Rodriquez G, Hendrick E. Renal and peri-renal abscesses in children: proposed physio-pathologic mechanisms and treatment algorithm. Pediatr Surg Int 2003; 19 (1–2) 35-39
    CrossrefPubMedGoogle Scholar
  • 35 Chaudhry S, Bolt R. Bilateral renal abscess in a previously healthy 11-year-old girl. Eur J Pediatr 2010; 169 (11) 1423-1425
    CrossrefPubMedGoogle Scholar
  • 36 Kawashima A, Sandler CM, Goldman SM. Imaging in acute renal infection. BJU Int 2000; 86 (Suppl. 01) 70-79
    CrossrefPubMedGoogle Scholar
  • 37 Shimizu M, Katayama K, Kato E, Miyayama S, Sugata T, Ohta K. Evolution of acute focal bacterial nephritis into a renal abscess. Pediatr Nephrol 2005; 20 (1) 93-95
    CrossrefPubMedGoogle Scholar
  • 38 Hoddick W, Jeffrey RB, Goldberg HI, Federle MP, Laing FC. CT and sonography of severe renal and perirenal infections. AJR Am J Roentgenol 1983; 140 (3) 517-520
    CrossrefPubMedGoogle Scholar
  • 39 Kao CT, Tsai JD, Lee HC , et al. Right perinephric abscess: a rare presentation of ruptured retrocecal appendicitis. Pediatr Nephrol 2002; 17 (3) 177-180
    CrossrefPubMedGoogle Scholar
  • 40 Wippermann CF, Schofer O, Beetz R , et al. Renal abscess in childhood: diagnostic and therapeutic progress. Pediatr Infect Dis J 1991; 10 (6) 446-450
    PubMedGoogle Scholar
  • 41 Gervais DA, Brown SD, Connolly SA, Brec SL, Harisinghani MG, Mueller PR. Percutaneous imaging-guided abdominal and pelvic abscess drainage in children. Radiographics 2004; 24 (3) 737-754
    CrossrefPubMedGoogle Scholar
  • 42 Siegel JF, Smith A, Moldwin R. Minimally invasive treatment of renal abscess. J Urol 1996; 155 (1) 52-55
    PubMedGoogle Scholar
  • 43 Benifla M, Weizman Z. Acute pancreatitis in childhood: analysis of literature data. J Clin Gastroenterol 2003; 37 (2) 169-172
    CrossrefPubMedGoogle Scholar
  • 44 Stamatakos M, Stefanaki C, Kontzoglou K, Stergiopoulos S, Giannopoulos G, Safioleas M. Walled-off pancreatic necrosis. World J Gastroenterol 2010; 16 (14) 1707-1712
    CrossrefPubMedGoogle Scholar
  • 45 King LR, Siegel MJ, Balfe DM. Acute pancreatitis in children: CT findings of intra- and extrapancreatic fluid collections. Radiology 1995; 195 (1) 196-200
    PubMedGoogle Scholar
  • 46 Yachha SK, Chetri K, Saraswat VA , et al. Management of childhood pancreatic disorders: a multidisciplinary approach. J Pediatr Gastroenterol Nutr 2003; 36 (2) 206-212
    CrossrefPubMedGoogle Scholar
  • 47 Beger HG, Rau BM. Severe acute pancreatitis: clinical course and management. World J Gastroenterol 2007; 13 (38) 5043-5051
    CrossrefPubMedGoogle Scholar
  • 48 Ocampo C, Zandalazini H, Kohan G, Silva W, Szelagowsky C, Oría A. Computed tomographic prognostic factors for predicting local complications in patients with pancreatic necrosis. Pancreas 2009; 38 (2) 137-142
    CrossrefPubMedGoogle Scholar
  • 49 Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol 1998; 170 (4) 969-975
    CrossrefPubMedGoogle Scholar
  • 50 Vernacchia FS, Jeffrey Jr RB, Federle MP , et al. Pancreatic abscess: predictive value of early abdominal CT. Radiology 1987; 162 (2) 435-438
    PubMedGoogle Scholar
  • 51 Lee MJ, Wittich GR, Mueller PR. Percutaneous intervention in acute pancreatitis. Radiographics 1998; 18 (3) 711-724 ; discussion 728
    PubMedGoogle Scholar
  • 52 Amundson GM, Towbin RB, Mueller DL, Seagram CG. Percutaneous transgastric drainage of the lesser sac in children. Pediatr Radiol 1990; 20 (8) 590-593
    CrossrefPubMedGoogle Scholar
  • 53 Burnweit C, Wesson D, Stringer D, Filler R. Percutaneous drainage of traumatic pancreatic pseudocysts in children. J Trauma 1990; 30 (10) 1273-1277
    CrossrefPubMedGoogle Scholar
  • 54 vanSonnenberg E, Wittich GR, Casola G , et al. Percutaneous drainage of infected and noninfected pancreatic pseudocysts: experience in 101 cases. Radiology 1989; 170 (3 Pt 1) 757-761
    PubMedGoogle Scholar
  • 55 Mortelé KJ, Girshman J, Szejnfeld D , et al. CT-guided percutaneous catheter drainage of acute necrotizing pancreatitis: clinical experience and observations in patients with sterile and infected necrosis. AJR Am J Roentgenol 2009; 192 (1) 110-116
    CrossrefPubMedGoogle Scholar
  • 56 Seewald S, Ang TL, Richter H , et al. Long-term results after endoscopic drainage and necrosectomy of symptomatic pancreatic fluid collections. Dig Endosc 2012; 24 (1) 36-41
    CrossrefPubMedGoogle Scholar
  • 57 Choudhury SR, Debnath PR, Jain P , et al. Conservative management of isolated splenic abscess in children. J Pediatr Surg 2010; 45 (2) 372-375
    CrossrefPubMedGoogle Scholar
  • 58 Ramakrishnan MR, Sarathy TK, Balu M. Percutaneous drainage of splenic abscess: case report and review of literature. Pediatrics 1987; 79 (6) 1029-1031
    PubMedGoogle Scholar
  • 59 Ooi LL, Leong SS. Splenic abscesses from 1987 to 1995. Am J Surg 1997; 174 (1) 87-93
    CrossrefPubMedGoogle Scholar
  • 60 Chiang IS, Lin TJ, Chiang IC, Tsai MS. Splenic abscesses: review of 29 cases. Kaohsiung J Med Sci 2003; 19 (10) 510-515
    CrossrefPubMedGoogle Scholar
  • 61 Llenas-García J, Fernández-Ruiz M, Caurcel L, Enguita-Valls A, Vila-Santos J, Guerra-Vales JM. Splenic abscess: a review of 22 cases in a single institution. Eur J Intern Med 2009; 20 (5) 537-539
    CrossrefPubMedGoogle Scholar
  • 62 Kang M, Saxena AK, Gulati M, Suri S. Ultrasound-guided percutaneous catheter drainage of splenic abscess. Pediatr Radiol 2004; 34 (3) 271-273
    CrossrefPubMedGoogle Scholar
  • 63 Civardi G, Di Candio G, Giorgio A , et al. Ultrasound guided percutaneous drainage of abdominal abscesses in the hands of the clinician: a multicenter Italian study. Eur J Ultrasound 1998; 8 (2) 91-99
    CrossrefPubMedGoogle Scholar
  • 64 Chang KC, Chuah SK, Changchien CS , et al. Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. World J Gastroenterol 2006; 12 (3) 460-464
    PubMedGoogle Scholar
  • 65 Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA. Percutaneous CT-guided drainage of splenic abscess. AJR Am J Roentgenol 2002; 179 (3) 629-632
    CrossrefPubMedGoogle Scholar
  • 66 Bisharat N, Omari H, Lavi I, Raz R. Risk of infection and death among post-splenectomy patients. J Infect 2001; 43 (3) 182-186
    CrossrefPubMedGoogle Scholar
  • 67 Lucey BC, Boland GW, Maher MM, Hahn PF, Gervais DA, Mueller PR. Percutaneous nonvascular splenic intervention: a 10-year review. AJR Am J Roentgenol 2002; 179 (6) 1591-1596
    CrossrefPubMedGoogle Scholar
  • 68 Zerem E, Bergsland J. Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. World J Gastroenterol 2006; 12 (45) 7341-7345
    CrossrefPubMedGoogle Scholar
  • 69 Atkinson Jr GO, Kodroff MB, Gay Jr BB, Ricketts RR. Adrenal abscess in the neonate. Radiology 1985; 155 (1) 101-104
    PubMedGoogle Scholar
  • 70 Diepstraten SC, Zwaveling S, Beek FJ. Diagnosis and subsequent US-guided percutaneous drainage of an adrenal abscess in a 5-week-old infant. Pediatr Radiol 2012; 42 (9) 1126-1129
    CrossrefPubMedGoogle Scholar
  • 71 Paterson A. Adrenal pathology in childhood: a spectrum of disease. Eur Radiol 2002; 12 (10) 2491-2508
    PubMedGoogle Scholar
  • 72 Hogan MJ, Hoffer FA. Biopsy and drainage techniques in children. Tech Vasc Interv Radiol 2010; 13 (4) 206-213
    CrossrefPubMedGoogle Scholar
  • 73 Coté CJ, Wilson S. American Academy of Pediatrics; American Academy of Pediatric Dentistry; Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics 2006; 118 (6) 2587-2602
    CrossrefPubMedGoogle Scholar
  • 74 American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96 (4) 1004-1017
    CrossrefPubMedGoogle Scholar
  • 75 Coley BD, Hogan MJ. Image-guided interventions in neonates. Eur J Radiol 2006; 60 (2) 208-220
    CrossrefPubMedGoogle Scholar
  • 76 Lorenz JM, Funaki BS, Ray Jr CE , et al. ACR Appropriateness Criteria on percutaneous catheter drainage of infected fluid collections. J Am Coll Radiol 2009; 6 (12) 837-843
    CrossrefPubMedGoogle Scholar
  • 77 Matalon TA, Silver B. US guidance of interventional procedures. Radiology 1990; 174 (1) 43-47
    CrossrefPubMedGoogle Scholar
  • 78 vanSonnenberg E, Wittich GR, Edwards DK , et al. Percutaneous diagnostic and therapeutic interventional radiologic procedures in children: experience in 100 patients. Radiology 1987; 162 (3) 601-605
    PubMedGoogle Scholar
  • 79 vanSonnenberg E, Wittich GR, Casola G , et al. Complicated pancreatic inflammatory disease: diagnostic and therapeutic role of interventional radiology. Radiology 1985; 155 (2) 335-340
    PubMedGoogle Scholar
  • 80 Rao S, Hogan MJ. Trocar transrectal abscess drainage in children: a modified technique. Pediatr Radiol 2009; 39 (9) 982-984
    CrossrefPubMedGoogle Scholar
  • 81 Beland MD, Gervais DA, Levis DA, Hahn PF, Arellano RS, Mueller PR. Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology 2008; 247 (2) 567-573
    CrossrefPubMedGoogle Scholar
  • 82 Harisinghani MG, Gervais DA, Hahn PF , et al. CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome. Radiographics 2002; 22 (6) 1353-1367
    CrossrefPubMedGoogle Scholar
  • 83 Mueller PR, Ferrucci Jr JT, Simeone JF , et al. Lesser sac abscesses and fluid collections: drainage by transhepatic approach. Radiology 1985; 155 (3) 615-618
    PubMedGoogle Scholar
  • 84 Cahill AM, Baskin KM, Kaye RD, Fitz CR, Towbin RB. Transgluteal approach for draining pelvic fluid collections in pediatric patients. Radiology 2005; 234 (3) 893-898
    CrossrefPubMedGoogle Scholar
  • 85 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 (5) 1393-1396
    CrossrefPubMedGoogle Scholar
  • 86 vanSonnenberg E, Ferrucci Jr JT, Mueller PR, Wittenberg J, Simeone JF. Percutaneous drainage of abscesses and fluid collections: technique, results, and applications. Radiology 1982; 142 (1) 1-10
    PubMedGoogle Scholar
  • 87 Jaffe RB, Arata Jr JA, Matlak ME. Percutaneous drainage of traumatic pancreatic pseudocysts in children. AJR Am J Roentgenol 1989; 152 (3) 591-595
    CrossrefPubMedGoogle Scholar
  • 88 Pereira JK, Chait PG, Miller SF. Deep pelvic abscesses in children: transrectal drainage under radiologic guidance. Radiology 1996; 198 (2) 393-396
    PubMedGoogle Scholar
  • 89 Butch RJ, Mueller PR, Ferrucci Jr JT , et al. Drainage of pelvic abscesses through the greater sciatic foramen. Radiology 1986; 158 (2) 487-491
    PubMedGoogle Scholar
  • 90 Alexander AA, Eschelman DJ, Nazarian LN, Bonn J. Transrectal sonographically guided drainage of deep pelvic abscesses. AJR Am J Roentgenol 1994; 162 (5) 1227-1230 ; discussion 1231–1232
    CrossrefPubMedGoogle Scholar
  • 91 Haaga JR, Nakamoto D, Stellato T , et al. Intracavitary urokinase for enhancement of percutaneous abscess drainage: phase II trial. AJR Am J Roentgenol 2000; 174 (6) 1681-1685
    CrossrefPubMedGoogle Scholar
  • 92 Goldberg MA, Mueller PR, Saini S , et al. Importance of daily rounds by the radiologist after interventional procedures of the abdomen and chest. Radiology 1991; 180 (3) 767-770
    PubMedGoogle Scholar