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Ilio-psoas abscess in the paediatric population: treatment by US-guided percutaneous drainage
1Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Insights
Ultrasound-guided percutaneous drainage is a safe and effective treatment for pediatric ilio-psoas abscesses. This minimally invasive approach offers a viable alternative to surgery in children, with most patients showing rapid improvement.
Area of Science:
- Pediatric surgery
- Interventional radiology
- Infectious disease management
Background:
- Psoas abscess management in children lacks extensive data.
- Image-guided percutaneous drainage is established for adults and adolescents.
- This study focuses on pediatric ilio-psoas abscesses.
Purpose of the Study:
- To assess the safety and efficacy of ultrasound-guided percutaneous drainage for pediatric ilio-psoas abscesses.
- To evaluate both needle aspiration and catheter drainage techniques.
- To compare percutaneous drainage with surgical intervention in children.
Main Methods:
- Retrospective review of 14 children with 16 ilio-psoas abscesses.
- Abscesses included pyogenic and tuberculous types.
- Treatment involved ultrasound-guided percutaneous needle aspiration or catheter drainage with antimicrobial therapy.
Main Results:
- Successful percutaneous treatment in 10 of 14 patients.
- Clinical improvement within 24-48 hours for successful cases.
- Surgery was avoided in most successful cases; no procedural complications reported.
Conclusions:
- Percutaneous drainage is an effective alternative to surgery for pediatric ilio-psoas abscesses.
- It serves as a valuable adjunct to medical therapy.
- This approach can reduce the need for invasive surgical procedures in children.
Background:
Image-guided percutaneous drainage has been shown to be a safe and effective alternative to surgery in the management of psoas abscess in adults and adolescents. There is little information on its use in children.
Objective:
To evaluate the safety and efficacy of US-guided percutaneous needle aspiration and catheter drainage of ilio-psoas abscesses.
Materials And Methods:
A retrospective review of 14 children with 16 ilio-psoas abscesses (10 pyogenic and 4 tuberculous) who were treated by US-guided percutaneous needle aspiration (n = 5) or catheter drainage (n = 9) along with appropriate antimicrobial therapy.
Results:
Percutaneous treatment was successful in 10 of the 14 patients; all showed clinical improvement within 24-48 h of drainage and subsequent imaging demonstrated resolution of the abscess cavities. Surgery was avoided in all of these ten patients except one, who underwent open surgical drainage of ipsilateral hip joint pus. Of the other four patients, two had to undergo surgical drainage of the ilio-psoas abscesses after failure of percutaneous treatment, one improved with antibiotics after needle aspiration failed to yield any pus, and one died of continuing staphylococcal septicaemia within 24 h of the procedure. There were no procedural complications.
Conclusions:
Percutaneous drainage represents an effective alternative to surgical drainage as a supplement to medical therapy in the management of children with ilio-psoas abscesses.