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Published on: March 15, 2024
Percutaneous imaging-guided abdominal and pelvic abscess drainage in children
Debra A Gervais1, Stephen D Brown, Susan A Connolly
1Department of Radiology, Massachusetts General Hospital, 34 Fruit St, White 270, Boston, MA 02115, USA. dgervais@partners.org
Insights
Percutaneous imaging-guided drainage is a safe and effective first-line treatment for abdominal and pelvic abscesses in children, achieving 85%-90% success rates. This minimally invasive procedure requires specialized pediatric adaptations for optimal outcomes.
Area of Science:
- Interventional Radiology
- Pediatric Surgery
- Medical Imaging
Background:
- Percutaneous imaging-guided drainage is the primary treatment for symptomatic abdominal and pelvic fluid collections when immediate surgery is not indicated.
- This minimally invasive technique is adaptable for pediatric patients, utilizing readily available technology and expertise.
- Common catheter insertion methods include trocar and Seldinger techniques, with imaging guidance typically employing ultrasonography (US), computed tomography (CT), or a combination of US and fluoroscopy.
Purpose of the Study:
- To highlight the efficacy and adaptability of percutaneous imaging-guided drainage for pediatric abdominal and pelvic abscesses.
- To discuss the specific considerations and adaptations necessary for performing these procedures in children.
- To emphasize the role of interventional radiologists in successfully managing pediatric abscesses non-surgically.
Main Methods:
- Review of percutaneous drainage techniques, including trocar and Seldinger methods.
- Discussion of imaging guidance modalities such as ultrasonography, computed tomography, and fluoroscopy.
- Analysis of various access approaches for difficult-to-reach abscesses (e.g., transrectal, transgluteal, intercostal, transhepatic).
Main Results:
- Percutaneous abscess drainage demonstrates high success rates in children (85%-90%), comparable to adults.
- The causes of pediatric abscesses may differ slightly from adults, but treatment efficacy remains similar.
- Successful drainage can often obviate the need for surgical intervention.
Conclusions:
- Interventional radiologists can successfully manage most pediatric abscesses using imaging-guided drainage techniques.
- Adaptation for pediatric practice requires specific attention to sedation, monitoring, temperature regulation, radiation dose minimization, and family involvement.
- This approach offers a safe and effective alternative to surgery for pediatric abdominal and pelvic abscesses.
Abstract:
Percutaneous imaging-guided drainage is the first-line treatment for infected or symptomatic fluid collections in the abdomen and pelvis, in the absence of indications for immediate surgery. The technology and expertise needed to perform percutaneous abscess drainage are widely available and readily adapted for use in the pediatric population. Catheter insertion procedures include the trocar and Seldinger techniques. Imaging guidance for drainage is most commonly performed with ultrasonography (US), computed tomography, or US and fluoroscopy combined. Abscesses in locations that are difficult to access, such as those deep in the pelvis, subphrenic regions, or epigastric region, can be drained by using the appropriate approach-transrectal, transgluteal, intercostal, or transhepatic. Although the causes of abscesses in children differ slightly from those of abscesses in the adult population, the frequency of successful treatment with percutaneous abscess drainage in children is 85%-90%, similar to that in adults. With expertise in imaging-guided drainage techniques and the ability to adjust to the special needs of children, interventional radiologists can successfully drain most abscesses and obviate surgery. Successful adaptation of abscess drainage techniques for pediatric use requires attention to the specific needs of children with respect to sedation, dedicated resuscitation and monitoring equipment, avoidance of body heat loss, minimization of radiation doses, and greater involvement of family compared with that in adult practice.
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