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Interventional drainage of appendiceal abscessesin children. AJR Am J Roentgenol

 ARTICLE  in  AMERICAN JOURNAL OF ROENTGENOLOGY · JANUARY 1998

Impact Factor: 2.74 · DOI: 10.2214/ajr.169.6.9393176 · Source: PubMed

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A JR :1 69 , D ece mb er 19 97

1619

In te rv e n tio n a l D ra in a g e o f

A p p e n d ic e a l A b s c e ss e s in C h ild re n

D ou glas H . J am ies on1

P ete r 6 . C ha it2

Rob er t Fi l ler3

O B J E C T I V E .

Th is s tud y w as u nder taken to va lida te the ou tcom e of in te rven tion al d ra in -

age and IV an tib io tics fo r th e trea tm en t o f a ppend ice a l ab sce sse s in ch ild ren .

M A T E R IA LS A N D M E T H O D S . B etw e e n M a rch 19 9 1 an d M a rch 19 9 5 46 c h ild re n

w ith o ne o r m ore in tra a bdom in a l ap pend ice a l absc esses w e re se en at a ter tiary c are re fer ra l

c e n t e r . The ch ild ren rece ived IV an tib io tic s and underw en t in te rven tiona l d ra in ag e of th eir

col lec t ions .

A ll p rocedu res w ere perfo rm ed in the rad io log y in te rven tion su ite us ing IV sed a-

t io n an d

in o ne pa tien t, a genera l anesth etic . A ll pa tien ts w ere fo llow ed up for a t leas t 1 year .

R E S U L T S .

The 46 pa tien ts u nde rw en t 64 p ro cedu re s . T he se in c lu ded th e ins e rtion o f 3 4

p ercu tan eo us d ra in ag e ca th ete rs , the inse rtion of 25 tran srec ta l d rainage cathe te rs , an d five

need le asp ira tio ns. Fo ur pa tien ts d id no t respon d to th eir in itia l t reatm ent an d req u ired su r-

gery . O ne p atien t deve loped a co lon ic fistu la tha t reso lved spon tan eo usly .

C O N C L U S I O N .

S ucces s fu l tre a tm en t o f 42 pa tien ts 9 1 ) ju s tif ie s im age-g u id ed dra in -

ag e

and IV an tib io tics as

ap propr ia te m anagem ent fo r append icea l abscesses in

ch i ld ren .

R ec eiv ed F eb ru ary 2 8, 1 99 7; a cc ep te d a fte r re vis io n

May28 , 1997 .

1 Departm en t o f Ra d io logy , B .

C ’s C h il dr en ’s H o sp it al ,

4 4 80 O a k S t V a nc o uv e r B C V 6 H 3 V 4 C a na d a A d d re s s

c or r e s ponde nc e

to 0 . H . J am ie so n.

2D epa rtm en t o f D ia gn os tic Im ag ing , Th e H osp ita l fo r S ick

C hild re n, 5 55 U niv ers ity A ve ., T oro nto , O nta rio M 5G 1 X8 ,

Can ad a .

3Depar tmen t

o f P ed ia tric S urge ry , Th e H osp ita l fo r S ic k

C hild re n, T or on to , O nta rio M 5G 1X8 , Canada .

AJR 997 ; 69 : 6 9 622

0361-803X/97 /1696-1619

©

A m e r ic a n R o e n tg e n R a y S o c i et y

T h is rep ort p resen ts our exp er ience

in m anag ing in traabdom inal ap -

p en d icea l ab scesses in ch ild ren

us i ng

in te rve n tion a l d ra ina ge p ro cedu res

an d

Iv

ant ibiot ics .

P ercu tan eous dra inage o f in tr aa bd om in al

a bs ce ss es b y a n in te rv en tio na l rad io log ist has

b e c ome

a

w ell-accep ted prac tice in bo th

a d u lts a n d ch ild re n [1 6 ]. T w o

s tud ies on ap -

p end icea l ab scess d ra inage repo rted in the

No r t h Am e ric an rad io lo g y lite ra tu re relied

grea t ly on

C T -gu id e d dra in a ge and in c lu d ed

la rge ly adu lt p opu la tions [7 . 8 ]. In a th ird , ea r-

h e r, s tu dy rep orted in the E uro pean surg ica l

lite ra tu re , son ograph y w as u sed

[ 91 .

W e used

sonog ra ph y and C T

fo r d ia gn os is

bu t pe r-

fo rmed

a ll d ra in ag e p ro ce du re s w ith tra nsab-

dom ina l rea l-tim e son ograph ic gu idance .

O ur s tu d y in c lud ed 46 pa tien ts tre a te d o ve r

a

4-y ea r pe rio d . M an agem ent requ ired clo se

co lla b o ra tio n be tw een th e d iv is io ns of su r -

gery and rad io log y . A ll pa tien ts w ere fo l-

low ed up fo r

a t le as t

1 year. T h e successfu l

pa tien t ou tcom e in ou r s tu dy g ro up va lid a te s

o ur m a na ge m en t.

M ater ia ls a n d M e th o d s

B etw een M arch 1 991 and M a rch 1995 th e in-

te rven t iona l serv ice in con jun ction w ith th e gen -

e ra l s ur gic al se rv ic e tre ated

46 pa tien ts w ith

ap pend iceal abscess. P ertin en t in fo rm atio n abou t

the se pa tien ts w as o bta ined by rev iew of their

med i c a l

r eco r ds an d ou r in te rv en tio n d ata bas e.

C harts, inc lud ing ou tpa tien t n o tes an d correspon -

de nc e

w ere rev iew ed to at leas t 1 y ear af ter h osp i-

t al d is c ha rg e.

A ll pa tie n ts un derw ent so nog rap hy a s a d iagn os-

tic s tudy and

a s an aid to p lann ing c ath ete r p lac e-

m ent for absces s d rain age . In 24 pat ien ts IV

co n trast-enhanced ab dom ina l C T

w as

perfo rm ed to

a id d ia gn os is an d b eu e r define the lo ca tion of ab-

sce sses . C l’ w as espec ia lly use fu l w h en s on og ra ph ic

a c c e s s

w a s r es tr ic te d

an d

w hen m ult ip le co lle ctio ns

w ere no ted o r s usp ec ted  F igs . lA an d lB .

A ll p ro ce du re s we re do ne in the in terven tio nal-

ang iograph ic

suite

tha t w as equ ipp ed w ith C -a rm

f l uor os c opy

and an XP 128 so nograph y un it A cu -

son , M ounta in V iew , CA w ith 3 .5-, 5 -,

and 7-M Hz

pro bes . O ne pa tien t rece ived gene ral a nes the tic ; the

rem ain ing 45 pa tien ts rece ived an IV seda tive

an d

loc al an esth etic . Fo r p atien ts w eig h in g less than

20 kg , w e used 3 m g /kg of IV pento barb ita l sod ium

 N em buta l; A bbott , To ron to , C anad a an d I m g/kg

ofIV m eperid ine hydroch lo ride D em ero l; A bbo tt .

For pa tien ts w eig h ing m ore than 2 0 kg , w e u sed 0 .1

m g/kg ofIV diazepam D iazem u ls ; P harm ac ia and

Up joh n , D on M ills. C anada and 1 m g /kg o f IV

m ep er id in e h yd ro ch lo rid e. L id oc ain e h yd ro ch lo rid e

1 Xy locaine ; A s tra P harm a, M iss issaug a , C an -

ad a to a m axim um of0 .5 m i/kg w as u sed fo r lo ca l

anesthes ia. A nurse w ith appropria te tra in ing and

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Jam ieson e t a l.

1620

A JR :1 69 D e ce m be r 1 99 7

F ig . 1 . - li - y ea r-o ld

boyw ith m ultip le in tra abdom ina l a bscesses a fte r su rg ery fo r rup tu red append ix .

A and B , IV contrast-en han ced CT scans rev eal  A l o b ul a te d r im - e n h an c i ng l ef t f la nk a bs ce ss  as te r i sk and B

r im - en h an c in g a b sc e ss

 as te r i sk

in p elv is . N ote c on tig uity be tw een pe lv ic abscess and le ft an te rio r rec tal w all.

C,

Abdom ina l ra d iograph show s pe rcu taneous ly p laced d ra in age ca the te r in le ft flan k and tra ns rec ta lly inse rte d

d r a in a g e c a t he t er in o ptim al p ositio n, s lig htly le ft o f m id lin e.

the attend ing rad io lo g is t a dm in istered th e seda tiv e

an d m on ito re d s ed atio n. A ll p atien ts had pu lse ox -

ime try , b loo d pressure , a nd EC G m onito rin g d ur-

ing th e sed ation .

D eep pe lv ic co llec tions w ere pre fe ren tia lly

dra i ned th rou gh a trans rec ta l app roa ch [10] .

Transabdomina l so no graphy thro ug h th e aco ust ic

window o f th e b ladde r a llow ed d ire ct v isual izat ion

of a rec ta l ly inserte d s tiff p last ic enem a tip inden t-

ing the ab sces s. A n I 8-gau ge troca r ne ed le w a s

a dv an ce d t hr ou gh the lum en of th e enem a tip in to

the absces s un der d ire ct sono graph ic g u id an ce

 F ig . 2 . Su per fic ia l in traab dom in al ab sce ss co l-

lect ion s w e re pu nctured u nd er so no graph ic gu id-

anc e u sin g a 16 - or 1 8-g au ge sh eathed need le .

D eeper co llec tio ns w ere accessed w ith a 2 2 -g a ug e

Ch iba need le , a nd a N eff In tro ducer sy stem

 Cook : B loom in gto n , IN w a s used to a llow p lac e-

men t of a 0 .035 -in ch guidew ire . T he sh orte st o r

safest rou te of drain age w as ch osen to avo id con -

tam in atio n of a seco nd body com pa rtm ent , a so l id

o r g an , n e u ro v a s cu l a r s truc tu res or th e b ow el. Pu s

w as asp ira ted to co nfirm the d iag no sis, an d an

eq ua l v o lum e of w ater-so lu b le iod ina ted co ntrast

med ium was u sed to rep lac e the pu s. T his m e tho d

a ss is te d f lu o ro sc op ic guidan ce of gu idew ire p lac e-

m ent, t ract d i la ta tio n ,

and p lacem en t o f

a fixed

loo p drainage c ath ete r F ig . 3 . S ta nda rd equip-

m ent includ ed a 0 .035 -in ch g uid ew ire o r th e sti ffe r

Am p la tz g u idew ire C ook , d ila to rs app ropria te

fo r th e siz e o f the drain age c ath eter , an d 8 - to 14-

Fren ch fixed-loop a ll-pu rpo se dra inage ca th e te rs .

W e a ttem pted to dra in the ab scess com ple te ly and

m o n it or ed d r ai na g e

by son og rap hy [1 1]. W e w ere

no t re luctan t to p lace m ultip le cathete rs to com -

ple te ly drain m ult ip le or m ulti locu la r co lle ctio ns

 F igs. 1C and 4 . C a the ters w ere left in p lace for

fre e drainage and w ere flush ed w ith 2-3 m l o f sa-

lin e ev ery 6 h r to m a in tain patency . C ath eters w ere

rem ov ed w hen pus w as no lon ger dra in in g an d

when less than 5-1 0 m l o f se rosang uin eou s flu id

w as dra in ing pe r day . S ino gram s w ere o bta ined

o nly if c ath ete r d rain ag e w as p ers iste n t or fecu -

len t. C ollect ion s tha t w ere sm all o r d iffic u lt to ac -

cess

wi th

la rge r ca libe r d ra inage ca the ters w ere

asp ira te d o nly .

Pat ien ts w e re adm itted b y th e at ten d in g g en eral

surgeo n fo r ob servat ion and IV an tib io tic treatm ent,

wh ich con t inu ed fo r a m in im um of 5 day s a fter

dra inage . A ntib io tic p ro toco ls varied in th is stud y

grou p. T he th ree m ain p ro to co ls w ere , f irs t, 3 -6 m g/

kg of gen tam icin su lfa te

per day and

30 m g /kg of

m etro n idazo le per day ; second , 3 -6 m g /k g of gen-

tamic in su lfa te per day , 30 m g/kg o f m etro n idazo le

pe r d ay , and 150-200 m g /kg of am picill in per day ;

an d thi rd 3-6 m g/k g of g en ta mic in s ulfa te p er d ay

150 -200 m g/kg of am pic illin per day , and 15-25

m g /k g o fc li nd am y ci n

p er d ay .

Resu l ts

Forty -s ix pa tie n ts unde rw en t 64 in te rven-

tio na l p ro ce du re s. Thirty -tw o pa tien ts had

presen ted afte r an append ec tom y of w hom

a ll bu t o ne had pe rfo ra tion ev id en t a t s u rgery

an d 14 had no prev iou s su rgery . Sev en of the

pa tien ts w ho d id no t und ergo appen dectom y

had de la yed e lec tive surge ry to a ttem pt re -

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F

F 2 . 8 cabsces t o rap -

p en dic ea l ru ptu re . F s lin e s ag itta l so no gra m o f r etro ve s-

ic al a bsc ess sh ow s

1 8-g au ge tro ca r n ee dle

 arrow

enter ing co l lec t ion

f rom a nte rio r re cta l w all. P un ctu re

w a s p er fo rm e d

d ur in g d ire ct re al- tim e im ag in g.

F i g . 3 . 1 5 ye a r o l d

g irl w ith p elv ic a bs cess a fte r a pp en de cto -

m y . L atera l flu oro sc opic im age show s in je cte d c on tras t m ate-

r ia l w ith in a bsce ss and dra ina ge ca the te r ad va nc ing o ve r

gu i de w i r e

i nt o c o ll ec ti on .

In te rv e n tio n a l D ra in a g e o f A p p e n d ic e a l A bs c es se s in C h ild ren

A JR :169 , D ecem ber 1 997

1621

Fig . 4 .-3 -year -o ld

b oy w it h

p e lv i c a b sc e ss e s

a fte r ru ptu re d ap pe nd ix . L ate ra l flu oro sc op ic

i m ag e s ho w s

tw o

t r an s r ec t a ll y p l a ce d

dra in -

age ca the ters. A fte r low er

d ra in w as p la ce d,

s o n o gr ap h ic e v al u at io n i nd i ca te d h i gh e r l oc u

la tion ha d not c lea red . S e co nd trans rec ta l

d ra in w as im med iate ly inserted in to h igh er co l-

lec tion to ensure co mplete evacua tion of pus .

m ov a l o f th e append ix o r the append icea l

rem nan t. In the o ther seven pa tien ts, no fu r-

th e r s u rg e ry w as done and t he d ia gn os is w as

presum ptive , be ing based o n c lin ical assess -

m en t a nd la ck o f o th e r c au se fo r in tra abdom i-

na l abscess bo th a t p resen tation and at

fo l low -up .

T he p atien ts

ran ged in age

fro m 1 to 15

years

(m ean ag e, 9 yea rs 4 m o n ths ). T he pro -

cedures perfo rm ed in c lu ded 34 perc u ta ne -

ou sly p laced d ra in ag e ca the ters, 25

I ransrecta l ly

p la ced dra in a ge ca the te rs , a nd

five asp ira tions. T h irteen pa tien ts (28 ) had

m ore than on e dra inage ca th ete r in se rted at

the tim e of in itia l in te rv en t ion , an d se ve n pa-

tien ts (15 ) retu rned

fo r p la ce me nt of add i-

tiona l d ra in age

ca the te rs

w h ere new

co llec tion s had d eve lo ped or reaccu m ula ted .

F our pa tien ts (9 ) d id n o t c lin ically im -

prove afte r abscess d rainage an d IV an tib io t-

ic s an d u n d erw e n t s u rg e ry . T h e d ec is io n to

op erate on these fou r pa tien ts w as m ade by

th e

s urg ic al s ta ff

on the

b as is o f lac k o f cl in i-

ca l im prov em en t in the pa tien t o r deve lop-

m en t o f periton itis. T hree o f the fou r pa tien ts

had su rgery befo re the ir in terven tio na l d ra in -

age pro ced ure , an d o ne had no t underg one

prev io us su rgery . T he tw o p atien ts in the

s tudy g roup w ith a d e te ct ed a p pe n di co li th un -

d erw en t s ur ge ry . In on e o f these tw o p atien ts ,

the append ico lith w as de tec ted on ly after the

in te rv en tio n a l d ra in a g e p roc e d u re . T w o pa -

tients h ad a pp en di ce al rup tu res th a t w e re no t

se a le d ; o ne o f

these pa tien ts had un dergon e

surgery and the o ther had no t.

T h e leng th of ho sp ita liza tion afte r d rain -

a ge ra ng ed

from 3 to 23 days mean , 7 d ays).

D ra inage ca the te rs rem ained in p osition fo r

1-7 da ys (m ean , 4 days). T he tw o pa tien ts in

the study grou p w ith sep ticem ia b o th had the

sep tic em ia a t th e tim e o f a b sce ss d ra in age .

B o t h

t he se p at ie nts

w ere hosp ita lized fo r an

ex tended tim e: 21 an d 23 day s.

N o c a th e te r- re la te d

wound seps is w as

no te -

w orthy at the tim e of d ischarge or fo llow -up ,

and no

ca th e te r trac t fa ile d to c lose

spon tane-

ous ly . O n ly one ca the te r- re la ted com plica tion

was de tec te d 2 ). T he pa tien t h ad pe rs is te n t

tub e d rain ag e tha t appea red fecu len t; a s ino -

gram c onf irm ed a co lon ic fistu la . T he p atien t

was c lin ica lly w e ll a nd d isc ha rg ed w ith a

dra inage tube le ft in p lace . A fte r 1 w eek the

dra inage

had s to pped and the

tu be w as re -

m ov ed . T he pa tien t has been fo llow ed u p for

1 yea r w itho u t even t.

D i s c us s i on

O ur in te rv en tio na l ap proach to abscess

d ra inage is agg ress iv e. W e attem pt to dra in

co llections com ple te ly a t the in itia l p rocedure ,

and w e are no t re luc tan t to p lace m ultip le

d ra ina ge ca th e te rs o r p e rfo rm se cond proce-

dure s to d ra in n ew or re cu r ren t co llec tion s .

W e succeed ed in avo id ing

opera tio n in 9 1

of pa tien ts . T h is ra te co m pares w ell w ith o th er

s tu d ies, w h ich have rep orted 62 [4 ] to 84

[1 ] success ra tes fo r abd om ina l d ra inage proce-

dures in a du lts an d an 88

]

success ra te fo r

abdo m ina l d ra inage procedures in ch ild ren . A

s tu dy o f 21 pa tien ts in a ll ag e groups w ith ap-

pend icea l abscess d ra inage gu ided by C T had a

91

s uc ce ss ra te [7 ] a s tu d y o f 2 0

per iappen-

d icea l

abscess pa tien ts h ad a 90 success ra te

[8 ] , and a

s tud y o f

2 7 pat ien ts h ad an 8 5

suc-

cess

rate [9 ]. O ur com plicatio n ra te was a low

2 . N o com plica tio ns w ere repo rted fo r one

append icea l abscess d ra inage s tudy [7 ], and fo r

ano th er stu dy one co m plica tion (5 ) w as re -

po rted [8 ]. L arg e s tu d ies o f in traabdom ina l

f lu id co llectio n d ra inage h av e h ad c om p li ca ti on

ra tes of 10 fo r a ll c o m p li ca ti o ns bu t 3 [1 ]

and 1 0 [4 ] fo r m ajo r com p lica tions. W e

w ould no t con side r add itio na l p lacem en t o f

ca the ters, m ino r re tu rn o f b lood , o r m in or pos t-

p rocedura l ba c t e r e m i a to be

unexpected

or a

com plica tio n . R epor ted m ajo r com plications

inc lude s ig n ifican t hem orrhage ; po stp ro cedu ra l

seps is

w ith d issem ina ted in travascu lar

coagu-

lopa thy ; transg ress ion in to the thorax w ith

pneum o thorax , hem othorax , o r em pyem a sev-

e r ing

of a m esen te r ic vessel [1 ]; transg re ssion

in to the bow el; f is tu la f or m at io n; m a lp os it io ne d

tubes ;

and accid en tal tube rem ov al. M in or

com plica tio ns cou ld inc lude se lf-lim itin g hem -

orrh age , w oun d sep sis, a nd un due pa in .

N one o f ou r p rocedures requ ired C T guid -

ance o f in it ia l n eed le p lac em en t,

a l though

C T w as ava ilab le to us. W e used a free -

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Ja m ie s o n et a l

1622 A JR :169 , D ece m ber 1 99 7

handed tech n ique us in g rea l-tim e so nogra -

phy to d irec tly v isu alize n eed le inse rtion .

T he tim e s pe nt a cq uir in g th is sk ill is w e ll re -

pa id b y its ve rsa til ity an d e ffec tiven e ss in a c

ce ss ing in tra ab d om in a l co llec tion s . In a b usy

rad io logy departm en t,

of

g rea t ad van tage is

no t ty in g u p a C T sca nn e r w ith

ex tended

in

te rvent iona l

procedures .

C T gu id e d p roc e

du res do no t p ro v ide rea l-tim e gu idance

du ring need le p lacem en t, an d access ou t o f

th e

p lan e of ax ia l scann in g is o ften requ ired ,

w hich

ca n be te ch n ica lly de m and in g .

W e h av e fo und transrec ta l d ra inage p roce -

dures su cce ss fu l an d d ese rv in g of g reate r pop-

u la rity . A ll 25 tran sre c ta l procedu res w ere

w ell to lera ted

an d h a d n o co m p lic a tion s .

Tr a ns r e c t a l

ca th ete rs a llow be tte r g rav ita tiona l

su m p dra inage of abscesses and have been

sh ow n to requ ire le ss ana lgesic and sho rte r

ho sp ita l s tay s

th an e ith er

percu taneous o r su r -

g ic a l

d ra in ag e o f d eep pe lv ic abscesses [10 ].

P atien t se lection fo r in itial in te rven tion al

d ra in ag e is im po rtan t a n d c lin ica l tr ia g e o f

pa t ien ts sh ou ld de tec t pa tien ts w ith d iffuse

p er iton itis a nd d ive r t tho se pa tie n ts to s u rg e ry

[12 ]. A p atien t w ith in fe c tio n a nd

a s us pe ct ed

abscess m us t be separa ted from a pa tien t w ith

an in flam m ato ry m ass o r ph legm on . P h leg -

m o n requ ire s o bse rv atio n w ith o r w ithou t an -

tib io tics [9

1 3]; a bs ce ss es requ ire d ra inage . A

locu la ted flu id co llec tion can b e d iagnosed us-

ing bo th so nograph y an d C T afte r IV con tras t

adm in is tration . For 24 p atien ts (52 ) , w e

used bo th techn iques to conf irm the d iagn osis .

S onogr a ph i c find ing s o f a round , ov al, so m e-

tim es locu la ted struc tu re

w ith rea so na b ly

w ell-d efm ed w alls and con ten ts o f vary in g

ec ho gen ic ity w h ich m ay c on ta in g as an d C T

fm dings of a rim en ha n c in g w a lle d structure

w ith u su a lly low d en s ity con ten t

and , aga in ,

po ss ib ly g as ind ic a te ab sce ss . T h e se ap pe a r

ances are no t abso lu te ly sp ecific fo r ab scess

[2 , 14], bu t asp ira tion o f con ten ts af te r in itia l

need le pu nc tu re conf irm s w hether the flu id is

in fe c ted o r p u ru len t [2 9 ].

T he tw o pa tien ts in our s tudy w ith iden ti-

f led a p pe nd ic o lith un de rw en t e a rly su rg e ry . A

s trong argum ent can be m ade to exc lude these

pa tien ts from in te rven tiona l d ra inage pro ce-

dures . W e b e lie ve th a t fu rthe r assessm en t o f

th is subg roup of pa tien ts is re qu ired b eca use

a n i nd ic at io n m ay b e p re se nt to dra in abscess

co l lec t ions , to a llo w th e pa tie n t to c lin ica lly

b ecom e d efe rvescen t, and then to p roceed to

laparo tom y to rem o ve the app en d ico lith .

C lea r ly , th is s ub g ro u p o f p a tie n ts is a t h igh

r isk

an d requ ires c lose c lin ica l

a sse ssm en t a nd

o bserv ation if in te rven tiona l d ra inage is to

p reced e append ico lith rem ova l.

O ur pa tien ts av e ra ge d a 1 w e ek ho sp ita liza

t ion a lthoug h ca the te rs rem ained

in situ fo r an

av erag e of4 day s . T he c lin ica l s eve rity o f i l lness

o n p resen ta tion and w hether the pa tien t has re-

ce ived IV an tib io tic s a re g rea te r de te rm inan ts o f

leng th of h osp ita l stay than is the su rg ica l o r in -

te rvent iona l

pro ced ure p erform ed . T he in te rve n-

tion al d ra in age of un ilocu lar o r sim ple abscesses

is w e ll accep ted a s e f fi c ie n t effec tive , o f low

morbid i ty , an d le ss d is rup tive p hy sio lo gica lly

than is su rg ica l d ra inage [15-17]. In terven t ional

dra inage ofco m plex or m u ltilocu la r abscesses is

m o re con trovers ia l. In o ur

e xp erie nc e, p atie nts

w ith com p lex or m ultilo cu la r abscesses a re

s icke r

an d have grea te r ph ysio log ic derang e-

m en t. A sligh tly im pro ved ou tcom e in ex-

trem ely ill p a tien ts w ith surg ica l ra the r th an

in te rven t iona l

a bsc ess d ra in ag e ha s

been re-

ported [17]. T re a ting th is ca tegory of p a tien t

requ ires close coopera tion w ith su rg ica l co l-

leagues

an d

d iligen t p a tien t m o nito ring to de-

te rm in e w hether in te rven tiona l d ra inage or

l a pa r o t om y

is bes t fo r th e ind iv id ua l pa tie n t.

T hese p atien ts m ay benefit from percu taneou s

dra inage of flu id co llec tion s to tem porize o r

de lay surgery w itho u t the expec tation of cu re .

F or th e fou r pa tien ts in ou r s tudy gro up w ho

u nd er we nt s ur ge ry th e s urg ic al p ro ce du re

w as

n ot c om p ro m is ed b y th e prio r in te rven tiona l

p lacem en t o f d ra inage ca the te rs . T he in te rest-

ing observa tio n th a t seven p atien ts w ere

“cured” of th eir a pp en dic ea l rup tu re an d ab -

sce ss w itho u t lap aro tom y is a

m atte r o f so m e

deba te . L on g te rm ou tco m e eva lua tio n of pa-

tie n ts und erg o in g d ela yed e lec tive a pp end ec-

tom y an d p atien ts no t und ergo ing de layed

e lec tive app endec to m y is p end ing .

Successfu l trea tm en t o f 42 (91 ) o f 46

ch i ld ren w ith o n ly on e sign ifican t cathe te r

com p lica tio n (2 ) jus tifies im age-gu id ed

dra inage an d

I V a nt ib io ti cs

a s ou r m ana g e

m ent of cho ice fo r append ix -re la ted abscess

in

ch i ld ren .

R e f e r e nc e s

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cu taneous dra inage of 25 0 abdom ina l abscess

and flu id c o lle ctions . I. Radio ogy 1984 ;15 l :

337-341

2 . M u eller P R , v an S onnenb erg E , F errucc i iT P e rcu -

taneous drainage of 25 0 a b d o m i n a l abscess and

f lu id c o lle ctions . H .

Radio ogy

1984;151:343-347

3.

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G S.

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c on ve ntio na l t re atm en t.

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30:532-535

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Ra

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