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Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
Transiliopsoas approach: an alternative route to drain pelvic abscesses in children
Samuel E Borofsky1, Chrystal Obi, Anne Marie Cahill
1Department of Interventional Radiology, The Children's Hospital of Philadelphia, Civic Center Boulevard, Philadelphia, PA, 19104, USA, sborofsky@gmail.com.
Insights
This study shows that the transiliopsoas approach is a safe and effective method for draining deep pelvic abscesses in children using ultrasound guidance. It offers a simpler and safer alternative to traditional methods.
Area of Science:
- Pediatric Interventional Radiology
- Minimally Invasive Surgery
- Abdominal Imaging
Background:
- Appendiceal perforations commonly lead to pelvic abscesses in children, requiring drainage.
- Deep pelvic abscesses pose drainage challenges due to surrounding anatomical structures.
- The transiliopsoas approach offers an alternative drainage route.
Purpose of the Study:
- To evaluate the safety and efficacy of the transiliopsoas approach for pediatric pelvic abscess drainage.
- To assess outcomes including success rates, complications, and clinical improvement.
Main Methods:
- Retrospective review of the transiliopsoas drainage technique over 5 years.
- Analysis of imaging, drain output, catheter dwell time, and complications.
- Ultrasound (US) guidance utilized for needle and catheter placement.
Main Results:
- Successful needle placement in 100% (14/14) of patients.
- Successful catheter placement in 13/14 patients; one had abscess wall rupture.
- 100% clinical improvement with no major complications; minor pain reported in 21.4%.
Conclusions:
- The transiliopsoas route is a safe and effective US-guided method for draining pediatric pelvic abscesses.
- This approach provides a more accessible and safer alternative for deep pelvic collections.
- The technique demonstrates high success rates and minimal complications in selected pediatric cases.
Objective:
To evaluate an alternative route of pelvic abscess drainage in children via a transiliopsoas approach.
Background:
Appendiceal perforations complicated by inflammatory masses, such as abscesses or phlegmon, are a common indication for abdominal drainage in pediatric interventional radiology. Certain locations of collections may present particular challenges for the operator, owing to numerous surrounding structures, including bowel and other pelvic anatomy. This series describes an alternative route for drainage, which involves traversing the iliopsoas muscle under US guidance to drain a deep pelvic abscess.
Materials And Methods:
Retrospective chart review was performed of the transiliopsoas approach for abscess drainage during a 5-year period. The technique, pre- and post-drainage imaging, aspiration/drain output, duration of catheter dwell, procedure-related complications and abscess recurrence were reviewed.
Results:
Transiliopsoas needle placement was successful in 14 of 14 patients (100%). Catheter placement was successful in 13 patients. Abscess wall rupture precluded catheter placement in one patient. Mean catheter duration was 4.9 days, with a range of 2 to 9 days. Clinical improvement was achieved in all 14 patients (100%). There were no major complications. Post-procedure pain with ambulation was reported in 3 of 14 patients (21.4%), which was successfully controlled in each case with medication, and resolved after 2 days.
Conclusion:
The transiliopsoas route is a safe and effective route for US-guided abscess drainage and catheter placement in children with deep pelvic collections. In selected cases, this approach provides a more easily accessible and safer route than more traditional interventional approaches.
