Appendiceal Abscess Imaging-Guided Drainage in Children: Can it Replace Laparotomy?
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- Category: Vol. 77, September 2009
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Appendiceal Abscess Imaging-Guided Drainage in Children: Can it Replace Laparotomy?,
ABDELHADY T. EMAM and FATMA M. AWAD
Abstract
Introduction: Acute appendicitis is the most common condition requiring emergency abdominal surgery in the pediatric population. Abscess formation is a serious conse-quence to the delayed diagnosis. Percutaneous imaging-guided drainage is the first-line of treatment for infected or symp-tomatic fluid collections in the abdomen and pelvis. The aim of this study is to determine the role of imaging-guided drainage in treating pediatric patients with appendiceal abscess.
Materials and Methods: The diagnosis of appendicitis was based on clinical data, ultrasound (US) and CT scan. Abscess was diagnosed by the presence of fluid collection, +/- air fluid level, having an enhanced wall on CT scan. Abscess drainage was performed guided by CT scan using Seldinger technique. Follow up was done by focused CT scan.
Results: The study consists of 33 pediatric patients, 18 males and 15 females, with age range of 6 to 15 years. Twenty-four cases (72.8%) had solitary abscesses. For four of them, needle aspiration was done and for the rest, catheter insertion was performed. Only in two cases, imaging-guided drainage failed, which warranted surgical interference. Nine cases (27.2%) had multiple collections. Six collections were treated by needle aspiration, while 16 had catheter insertion. Unfor-tunately, two of these cases, eventually, needed surgery. The drainage procedure for all cases was done guided by CT scan. Non-surgical complications occurred in two cases (6%). The mean dwell time of the inserted catheters was 6.2 days. The mean inpatient stay in the hospital was 10.3 days.
Conclusion: Imaging-guided percutaneous drainage is a safe and effective treatment for appendiceal abscesses in children. It can replace invasive surgery.