The role of tissue plasminogen activator in the management of complex intra-abdominal abscesses in children.
OBJECTIVE
The objective of this study is to assess the safety of fibrinolytic therapy using tissue plasminogen activator (tPA) in children with complex intra-abdominal abscesses.


BACKGROUND
Intra-abdominal abscesses are common in children. Antibiotics and percutaneous drainage are the mainstays of treatment, but drainage may be less effective when the fluid is thick or septated. Fibrinolytic therapy using tPA is effective in a rat model of intra-abdominal abscesses, has recently been reported for the treatment of intra-abdominal abscesses in adults, and is commonly used in the treatment of empyema in children.


METHODS
This is a retrospective review of all patients over a 10-year period who had intra-abdominal collections managed with tPA abscess drainage.


RESULTS
Sixty-four children had a total of 66 drains placed and 92 doses of tPA. Appendicitis was the cause of the abscesses in 52 of 64 children. Mean length of stay pre-tPA was 11.7 ± 7.63 days, mean time from drain insertion to tPA was 4.3 ± 3.78 days, and mean time from tPA to discharge was 8.6 ± 8.85 days. Thirty patients underwent an operation before tPA administration. No patients experienced bleeding complications, anastomotic or appendiceal stump leak, or wound dehiscence after the administration of tPA, and no patients had abnormalities in coagulation studies related to tPA administration. One child died of sepsis.


CONCLUSIONS
Tissue plasminogen activator is safe for the management of thick or septated intra-abdominal abscesses in children. A prospective controlled study will be needed to evaluate the efficacy of this technique.
Division of Pediatric Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
Anna C
AC
Shawyer
Joao G P V
JG
Amaral
Jacob C
JC
Langer
D018784:Abdominal Abscess / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D001064:Appendicitis / Q000150:complications; D002648:Child; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator