title: Ultrasound-guided transrectal drainage of deep pelvic abscesses in children: a modified and simplified technique.
abstract: BACKGROUND
  Appendicitis is a common cause of acute surgical abdomen in children and often presents after perforation. Intra-abdominal abscesses can be drained percutaneously via transabdominal, transgluteal or, in the case of deep pelvis abscess, via transrectal approach.
  
  
  OBJECTIVE
  To describe a modification of previously described techniques for transrectal drainage procedures, which involves the use of a transvaginal probe and a modified enema tip as a guide for the one-step trocar technique. We also aimed to evaluate the safety and effectiveness of this modified technique for drainage of deep pelvic abscesses in children.
  
  
  METHODS
  A retrospective review of medical records was performed to identify all patients who underwent transrectal abscess drainage at our pediatric institution during a 5-year period. Surgical and radiologic procedure notes and imaging studies were evaluated. The data were analyzed to determine technical and clinical success rates, and to evaluate for any procedure-related complication.
  
  
  RESULTS
  The study population consisted of 46 patients with a mean age of 10.9 years. Of the 46 children, 20 underwent transrectal abscess drainage solely using transrectal US for guidance; 2 also underwent minimal fluoroscopy at the time of transrectal drainage. Fifteen children required placement of one or more percutaneous transabdominal drains at the same time as transrectal catheter placement, and nine required addition percutaneous drainage catheters placed at another time. All transrectal drainage procedures were technically and clinically successful. There were no procedure-related complications.
  
  
  CONCLUSIONS
  The described modified technique for US-guided transrectal drainage of deep pelvic abscesses resulting from perforated appendicitis in children is safe, effective and relatively easy to perform, with the added benefit of omitting radiation exposure in children.
authors.affiliation: Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA, janicemcdanielmd@gmail.com.
authors.forename: Janice D
authors.initials: JD
authors.lastname: McDaniel
authors.forename: Mark T
authors.initials: MT
authors.lastname: Warren
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Pence
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Ey
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging* / Q000628:therapy*; D002648:Child; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010388:Pelvis / Q000000981:diagnostic imaging; D012007:Rectum; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*