Transrectal ultrasound and fluoroscopy-guided drainage of deep pelvic collections in children.
OBJECTIVE
Pediatric deep pelvic abscesses generally occur as a complication of perforated appendicitis or after laparoscopic appendectomy. We describe our technique and experience in imaging-guided transrectal drainage (TRD) of deep pelvic abscesses in children.


METHODS
From January 2005 to November 2008, imaging-guided TRD was attempted in 29 children. The procedure records and medical records were reviewed retrospectively.


RESULTS
Twenty-nine TRD procedures were performed in 17 males and 12 female patients. The mean age was 11.8 years (range, 3.8-15.9 years). Fourteen patients required TRD after an abdominal operative procedure: laparoscopic appendectomy (n = 9), open appendectomy (n = 3), exploratory celiotomy for gunshot wound (n = 1), and exploratory celiotomy with intestinal resection for adhesive bowel obstruction (n = 1). Fifteen patients were referred for TRD as initial therapy for deep pelvic fluid collections: perforated appendicitis (n = 14) and Crohn perforation (n = 1). Twenty-seven (93.1%) procedures were successful, described as either placement of a TRD catheter or aspiration of the deep pelvic fluid using transrectal approach. There were no procedure-related complications.


CONCLUSIONS
Imaging-guided TRD in children is a safe and easy procedure that allows drainage of deep pelvic abscesses that are otherwise not easily accessible.
Koral
Korgun
K
Department of Radiology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX 75235, USA. korgun.koral@utsouthwestern.edu
Derinkuyu
Betul
B
Gargan
Lynn
L
Lagomarsino
Elizabeth M
EM
Murphy
Joseph T
JT
D000038:Abscess / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000150:complications; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004322:Drainage / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D034161:Pelvic Infection / Q000000981:diagnostic imaging* / Q000601:surgery*; D011336:Probability; D015641:Radiography, Interventional; D012007:Rectum / Q000000981:diagnostic imaging; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*