Percutaneous drainage of intra-abdominal abscess in children with perforated appendicitis

Michael F McNeeley, Nghia Jack Vo, Somnath J Prabhu, Jason Vergnani, Dennis W Shaw
Pediatric Radiology 2012, 42 (7): 805-12

BACKGROUND: Because the surgical management of perforated appendicitis remains controversial, percutaneous catheter drainage (PCD) has gained favor for managing periappendiceal abscess in hemodynamically stable children.

OBJECTIVE: To determine the safety and effectiveness of PCD in children with perforated appendicitis and to identify any variables of prognostic value.

MATERIALS & METHODS: We retrospectively evaluated clinical data and imaging features for 33 children undergoing PCD for periappendiceal abscess from October 2006 to February 2010. Those with preprocedural CT studies were assigned to one of three risk categories based on imaging features.

RESULTS: Appendectomy was successfully postponed for all patients. Our technical success rate was 87.9%, with three recurrences (two requiring repeat drainage, one managed conservatively) and one possible complication (enterocutaneous fistula formation). Children with large and diffuse abscesses had a 50% rate of technical failure, which was significantly increased when compared to children with large but localized abscesses (P < 0.028). Extraluminal appendicolith, extraluminal gas, leukocytosis, ileus/obstruction and procedural variables were not reliable predictors of outcome.

CONCLUSION: PCD can be effective for managing perforated appendicitis in children. Children with large and ill-defined abscess might be at increased risk for complication or recurrence.

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