Appendiceal Abscess Imaging-Guided Drainage in Children: Can it Replace Laparotomy?

Introduction: Acute appendicitis is the most common condition requiring emergency abdominal surgery in the pediatric population. Abscess formation is a serious consequence to the delayed diagnosis. Percutaneous imaging-guided drainage is the first-line of treatment for infected or symptomatic fluid collections in the abdomen and pelvis. The aim of this study is to determine the role of imaging-guided drainage in treating pediatric patients with appendiceal abscess. Materials and Methods: The diagnosis of appendicitis was based on clinical data, ultrasound (US) and CT scan. Abscess was diagnosed by the presence of fluid collection, +/air fluid level, having an enhanced wall on CT scan. Abscess drainage was performed guided by CT scan using Seldinger technique. Follow up was done by focused CT scan. Results: The study consists of 33 pediatric patients, 18 males and 15 females, with age range of 6 to 15 years. Twentyfour cases (72.8%) had solitary abscesses. For four of them, needle aspiration was done and for the rest, catheter insertion was performed. Only in two cases, imaging-guided drainage failed, which warranted surgical interference. Nine cases (27.2%) had multiple collections. Six collections were treated by needle aspiration, while 16 had catheter insertion. Unfortunately, two of these cases, eventually, needed surgery. The drainage procedure for all cases was done guided by CT scan. Non-surgical complications occurred in two cases (6%). The mean dwell time of the inserted catheters was 6.2 days. The mean inpatient stay in the hospital was 10.3 days. Conclusion: Imaging-guided percutaneous drainage is a safe and effective treatment for appendiceal abscesses in children. It can replace invasive surgery.