McDaniel Janice D, Warren Mark T, Pence Jeffrey C, Ey Elizabeth H
Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA,
Pediatr Radiol. 2015 Mar;45(3):435-8. doi: 10.1007/s00247-014-3154-2. Epub 2014 Sep 14.
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.
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.
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.
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.
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.
阑尾炎是儿童急性外科急腹症的常见病因，常于穿孔后出现。腹腔内脓肿可通过经腹、经臀途径进行经皮引流，对于盆腔深部脓肿，可通过经直肠途径引流。
描述一种对先前所述经直肠引流术技术的改良方法，该方法使用经阴道探头和改良灌肠头作为一步式套管针技术的引导。我们还旨在评估这种改良技术用于儿童盆腔深部脓肿引流的安全性和有效性。
对病历进行回顾性分析，以确定在我们儿科机构5年期间接受经直肠脓肿引流的所有患者。评估手术和放射学操作记录以及影像学研究。分析数据以确定技术成功率和临床成功率，并评估任何与操作相关的并发症。
研究人群包括46例患者，平均年龄10.9岁。在这46名儿童中，20例仅使用经直肠超声引导进行经直肠脓肿引流；2例在经直肠引流时还进行了少量透视。15名儿童在经直肠置管的同时需要放置一根或多根经皮经腹引流管，9名儿童需要在其他时间额外放置经皮引流管。所有经直肠引流操作在技术和临床上均获成功。没有与操作相关的并发症。
所描述的用于超声引导下经直肠引流儿童穿孔性阑尾炎所致盆腔深部脓肿的改良技术安全、有效且相对易于实施，其额外好处是避免了儿童接受辐射暴露。
