Interventional drainage of appendiceal abscesses in children
D H Jamieson1, P G Chait, R Filler
1Department of Radiology, B. C.'s Children's Hospital, Vancouver, Canada.
Insights
Image-guided drainage and IV antibiotics effectively treat pediatric appendiceal abscesses, with 91% success. This approach avoids surgery for most children with these intraabdominal infections.
Area of Science:
- Pediatric Surgery
- Interventional Radiology
- Infectious Diseases
Background:
- Appendiceal abscesses in children can be complex to manage.
- Traditional management often involves surgical intervention.
Purpose of the Study:
- To validate the efficacy of interventional drainage combined with intravenous (IV) antibiotics for treating appendiceal abscesses in pediatric patients.
- To assess the outcomes and success rates of this minimally invasive approach.
Main Methods:
- A cohort of 46 children with intraabdominal appendiceal abscesses were treated with IV antibiotics and interventional drainage.
- Procedures included percutaneous drainage catheters, transrectal drainage catheters, and needle aspirations, performed under sedation in a radiology suite.
- Patients were followed for at least 1 year post-treatment.
Main Results:
- A total of 64 procedures were performed on the 46 patients.
- 42 out of 46 patients (91%) achieved successful treatment without requiring immediate surgery.
- One patient developed a colonic fistula which resolved spontaneously; four patients ultimately needed surgery.
Conclusions:
- Image-guided drainage and IV antibiotics represent a successful and appropriate management strategy for pediatric appendiceal abscesses.
- This minimally invasive approach offers a high success rate, potentially reducing the need for surgical intervention in children.
Objective:
This study was undertaken to validate the outcome of interventional drainage and IV antibiotics for the treatment of appendiceal abscesses in children.
Materials And Methods:
Between March 1991 and March 1995, 46 children with one or more intraabdominal appendiceal abscesses were seen at a tertiary care referral center. The children received IV antibiotics and underwent interventional drainage of their collections. All procedures were performed in the radiology intervention suite using IV sedation and, in one patient, a general anesthetic. All patients were followed up for at least 1 year.
Results:
The 46 patients underwent 64 procedures. These included the insertion of 34 percutaneous drainage catheters, the insertion of 25 transrectal drainage catheters, and five needle aspirations. Four patients did not respond to their initial treatment and required surgery. One patient developed a colonic fistula that resolved spontaneously.
Conclusion:
Successful treatment of 42 patients (91%) justifies image-guided drainage and IV antibiotics as appropriate management for appendiceal abscesses in children.
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