Endoscopic Ultrasound-Guided Drainage of Deep Pelvic Abscess in Children: Case Series

Abstract

Introduction: Acute appendicitis with perforation is the most common cause of deep pelvic abscess in children. Image-guided drainage of the deep pelvic abscess becomes a preferable standard procedure prior to surgical intervention. For pediatric population, only transcutaneous and transrectal imageguided are favorable accesses. Transrectal ultrasound with fluoroscopy-guided is the only pelvic abscess drainage technique, which access the abscess rectally, reported in pediatric population so far. Endoscopic ultrasound-guided drainage of pelvic abscess (EUS-DPA) has shown to be safe and feasible in adult. However EUS-DPA in children has never been reported. In this article, we report our experience in three successful cases of EUS-DPA in pediatric population. Methods: This is a retrospective single center case series for pediatric patients who underwent EUS-DPA during March 2013 to April 2015. Following are inclusion criteria. 1) Age group between 1 to 18 year old. 2) Abscess cannot be drain via percutaneous, transabdominal routes by US and/or CT guidance. 3) Peri-rectal or peri-colonic were consider as deep pelvic abscesses. Results: EUS-DPA was performed in 3 patients. Mean age of patients was 13 years. All three patient, the abscess developed due to rupture appendicitis. Median size of abscess was 41 mm x34 mm. All three patients received puncture site dilation, normal saline mixed with gentamicin flushing to abscess cavity. 7F x 4 cm double pigtail stent were placed in all patients. Stent was remove 2 weeks after EUS-DPA procedure. There was no complication from procedure in all patients. In 1 patients received transabdominal percutaneous drainage prior to EUS-DPA procedure. Patients became afebrile within 72 h after the procedures. The aspirated fluid grew Escherichia coli in 2 patients and Pseudomonas aeruginosa in 1 patient. CT showed resolution in all patients and stents were removed 2 weeks after procedure. Two patients underwent interval appendectomy 3 months after the procedure. All patients were asymptomatic on follow up in 6 month. Conclusion: EUS-DPA represents a safe and useful role for the deep pelvic abscess drainage in children. EUS-DPA might be the first option for single deep pelvic abscess drainage or a supplement to percutaneous drainage in case of multiple pelvic abscesses in pediatric population. Further studies will need to be performed to confirm the efficacy, safety and complications of EUS-DPA for the other causes and locations of pelvic abscesses.Figure 1Figure 2Figure 3