Image-guided drainage of multiple intraabdominal abscesses in children with perforated appendicitis: an alternative to laparotomy.
BACKGROUND
Appendicitis is the most common cause of an acute abdomen in children. With perforation, multiple intraperitoneal collections can be seen at presentation. In this situation, surgical treatment alone is rarely effective.


OBJECTIVE
To determine the role of image-guided drainage in treating patients with acute appendicitis complicated by multiple intraabdominal collections.


METHODS
A retrospective review of patient charts and interventional radiology records was performed to identify all patients with acute complicated appendicitis treated by multiple image-guided drainage procedures. Data reviewed included the number of drainages and aspirations performed, drain dwell time, the clinical course and temperature profile, and the length of inpatient hospital stay and any complications experienced.


RESULTS
The study population comprised 42 children with a mean age of 107.6 months. A total of 100 drainage catheters were inserted and 56 aspirations were performed. Of the 42 children, 24 were successfully treated at a single sitting, while 18 returned for further intervention. The mean drain dwell time was 8.18 days. The mean inpatient stay was 15.02 days. Treatment of the acute presentation with image-guided intervention was successful in 92.3% of children.


CONCLUSIONS
Successful management of acute perforated appendicitis with multiple intraabdominal abscesses can be achieved with multiple minimally invasive image-guided drainage procedures.
McCann
Jeffrey W
JW
Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, M5G 1X8, Ontario, Canada. jwjmccann@hotmail.com
Maroo
Sanjay
S
Wales
Paul
P
Amaral
Joao G
JG
Krishnamurthy
Ganesh
G
Parra
Dimitri
D
Temple
Michael
M
John
Philip
P
Connolly
Bairbre L
BL
D000005:Abdomen / Q000000981:diagnostic imaging; D018784:Abdominal Abscess / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D001064:Appendicitis / Q000150:complications*; D001831:Body Temperature; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D011856:Radiographic Image Enhancement / Q000379:methods; D011860:Radiography, Abdominal / Q000379:methods; D015642:Radiology, Interventional / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
D003287:Contrast Media