Ilio-psoas abscess in the paediatric population: treatment by US-guided percutaneous drainage.

Abstract

Image-guided percutaneous drainage has been shown to be a safe and effective alternative to surgery in the management of psoas abscess in adults and adolescents. There is little information on its use in children. To evaluate the safety and efficacy of US-guided percutaneous needle aspiration and catheter drainage of ilio-psoas abscesses. A retrospective review of 14 children with 16 ilio-psoas abscesses (10 pyogenic and 4 tuberculous) who were treated by US-guided percutaneous needle aspiration (n = 5) or catheter drainage (n = 9) along with appropriate antimicrobial therapy. Percutaneous treatment was successful in 10 of the 14 patients; all showed clinical improvement within 24-48 h of drainage and subsequent imaging demonstrated resolution of the abscess cavities. Surgery was avoided in all of these ten patients except one, who underwent open surgical drainage of ipsilateral hip joint pus. Of the other four patients, two had to undergo surgical drainage of the ilio-psoas abscesses after failure of percutaneous treatment, one improved with antibiotics after needle aspiration failed to yield any pus, and one died of continuing staphylococcal septicaemia within 24 h of the procedure. There were no procedural complications. Percutaneous drainage represents an effective alternative to surgical drainage as a supplement to medical therapy in the management of children with ilio-psoas abscesses.