US-guided Percutaneous Drainage Research Articles

Cholecystocholedocholithiasis as a cause of acute necrotizing pancreatitis in children

Aim. To improve treatment outcomes for acute biliary pancreatitis in children with cholecysto- and choledocholithiasis. Materials and methods. The authors conducted a retrospective analysis of the examination and treatment of 14 children aged 3–17 years with moderate and severe ABP. In 11 observations (78.5 %) the period from the onset of the disease to hospitalization comprised < 24 hours, in 3 observations (21.4 %) > 48 hours. All patients underwent a comprehensive examination including clinical, laboratory and instrumental diagnostics. Results. Ultrasound signs of acute cholecystitis were detected in 10 children (83.3 %), biliary hypertension – in 12 (85.7 %). Laparoscopic cholecystectomy was performed in 1 patient (7.14 %) within 72 hours from the onset of the disease; 1 child underwent open cholecystectomy with lithoextraction and drainage of the common bile duct according to Kerr technique. Open cholecystostomy with drainage of purulent-necrotic parapancreatitis was performed in 1 case. Endoscopic papillosphincterotomy, lithoextraction and cholangiography were performed in 4 children (28.6 %), 1 child additionally underwent stenting of the common bile duct and pancreatic duct. All patients were diagnosed with necrotizing pancreatitis and various types of parapancreatitis. Drainage of parapancreatitis in the Vladimirsky Moscow Regional Research Clinical Institute was performed in 5 (35.7 %) children: 2 (14.3 %) by open technique, in 2 (14.3 %) by laparoscopic sanation and in 1 by US-guided percutaneous drainage. Conclusion. Emergency endoscopic papillosphincterotomy with lithoextraction refers to a method of choice for the elimination of biliary hypertension in choledocholithiasis. Delayed or elective cholecystectomy is considered preferable for children with severe or moderately-severe acute biliary pancreatitis. The choice of drainage technique for infected parapancreatitis depends on the spread and sanation quality of purulent process.

Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review.

Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.

Splenic abscess due to Salmonella enterica infection successfully treated with percutaneous drainage.

A 66-year-old female presented to our hospital with diffuse abdominal pain and diarrhea. An abdominal CT showed a splenic abscess of 9.9 x 6.1 x 6.5 cm. A conservative approach with US-guided percutaneous drainage and antibiotic treatment was performed successfully. Splenic abscess is a rare complication of Salmonella spp infection. In selected cases, percutaneous drainage can be performed safely with good efficacy.

Presentation, management and outcomes of iliopsoas abscess at a University Teaching Hospital in Nepal.

Iliopsoas abscess (IPA) is an uncommon clinical disease and is often missed to diagnose due to vague clinical presentation. Early treatment with drainage and appropriate antibiotic therapy is necessary before sepsis sets in and become lethal. We conducted this study to evaluate clinical features, etiology, management strategies, and outcomes in patients with IPA from a University Teaching Hospital in Nepal. A retrospective analysis of 32 consecutive IPA cases managed at Tribhuvan University Teaching Hospital, Nepal for the period of January 2019 to February 2022 was carried out. The mean age was 42.5±19.1 years (range, 19-75 years) and the male: female ratio was 2.2:1. Two-thirds or more patients presented with fever, limp, fixed flexion deformity and/or low back pain. Ultrasonography (US) was diagnostic in 27 (84.4%) patients. Eighteen (56.3%) patients had primary IPAs, and 14 (43.7%) had secondary IPAs. Thirty (93.7%) patients were managed with US guided percutaneous drainage (PCD) and 2 (6.2%) patients underwent open surgical drainage. Drainage procedures were combined with antibiotics in all patients. Pus culture showed Staphylococcus aureus growing in the majority of cases (10 of 23, 43.5%). The hospital stay was longer in patients treated via surgical drainage compared to those who received PCD: 13days (range 12-14days) vs. 6.6days (range 4-13days), respectively. Recurrence of abscess was seen in 4 (12.5%) cases and all were successfully managed via a second PCD. There was no mortality. Varying clinical presentation of iliopsoas abscess demand a high index of suspicion for early diagnosis. Initial imaging modality in suspected case of IPA is US. US-guided PCD along with the appropriate antibiotics is a successful frontline treatment of IPAs with shorter hospital stay.

Comparative study of surgical drainage versus percutaneous drainage of psoas abscess

Background: Psoas abscesses (PAs) are a rare disease. Primary PA shows hematogenous spread from an unknown source while secondary PA shows direct extension of infection from neighboring organs. Early identification of PA treatment involving sufficient drainage has been aided by computed tomography and magnetic resonance imaging. Aims and Objectives: The aim of the study was to contrast open surgical drainage versus percutaneous drainage (PCD) as a kind of iliopsoas abscess treatment. Materials and Methods: All patients (a total of 50 patients taken) aged more than 18 years with PA were admitted to the Department of Surgery, BJMC between March 2022 and February 2023. Results: In our study, half of the patients receive surgical drainage while the other half receive ultrasonography-guided drainage using a pigtail catheter or needle aspiration. In our study, 50% of patients underwent PCD, of which 38% recovered, and another 50% underwent surgical drainage, of which 46% of patients made a full recovery. In our study, 42% of patients who underwent surgical drainage required a hospital stay of more than 10 days, compared to 40% of patients who underwent PCD. Conclusion: US-guided PCD with the appropriate antibiotics is safe and effective, with a shorter hospital stay, when used to treat PAs. If there is an underlying disease or if the PA is multiloculated, open surgical draining can be necessary.

Ultrasound-Guided Percutaneous Aspiration for the Treatment of Breast Abscess at a Tertiary Care Center in the Developing World.

Percutaneous ultrasound (US)-guided aspiration is the first line of management for breast abscess. Our study aimed to look at the success of US-guided percutaneous drainage in managing breast abscesses at a tertiary care center and additionally to look for any correlation between US features and failure rate. Methods: A retrospective review of the radiology database at a tertiary care hospital in Pakistan was done to identify 54 patients through non-probability convenience sampling who underwent a US-guided percutaneous aspiration with laboratory confirmation of abscess. A treatment course was observed for the development of complications or failure of treatment. A chi-square test was performed to correlate US features and patient characteristics with outcomes of treatment (p<0.05). Fisher's exact test was applied to evaluate the success of aspiration in small versus large abscesses, and in lactating versus non-lactating patients. Results: 75% of all women were successfully able to avoid surgery. Specifically, 80.6% of all lactating women and 66.7 %of non-lactating women with breast abscesses were successfully managed with US-guided percutaneous aspiration. Across a variety of parameters measured, including pathological and etiological factors, as well as features on imaging, no significant association was established between the variables and the failure of the intervention. Lowmorbidity and high patient satisfaction rates make percutaneous aspiration preferable to surgical intervention as a first-line treatment of breast abscess. Early use of antibiotics is recommended as an adjunct to drainage.

S1764 Localized Truncal Xanthoderma Secondary to Bile Leakage Post Laparoscopic Cholecystectomy

Introduction: Xanthoderma is a yellow to yellow-orange discoloration of the skin. The 2 main pathologies leading to xanthoderma are jaundice and carotenoderma. Although the most common mechanism for jaundice is the elevation of serum bilirubin, localized jaundice can rarely occur in the settings of bile leakage into the retroperitoneal space. Case Description/Methods: A 40-year-old female patient presented with biliary pain. Examination showed right upper quadrant tenderness. Initial labs revealed total bilirubin of 49 µmol/L, with a direct bilirubin of 47µmol/L (Table). The US abdomen showed cholelithiasis. MRCP showed a small distal CBD stone; CBD diameter was 9 mm. She underwent laparoscopic cholecystectomy with an intraoperative cholangiogram. The small distal CBD stone was pushed to the duodenum. Repeated IOC showed a smooth passage of contrast. Her clinical status didn’t improve postoperatively, and her bilirubin was persistently elevated. Localized yellowish discoloration of the right side of the abdominal wall and the suprapubic area was observed 5 days after the surgery (Figure A). Repeated MRCP showed suspicious distal CBD stone with gall bladder bed collection and diffuse inflammatory change of the right abdominal wall. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a bile leak at the site of the cystic stump (Figure A) and a small filling defect in the distal CBD. Sphincterotomy and CBD stenting were performed. The bilirubin improved gradually after ERCP, but the abdominal pain persisted. CT abdomen showed large perihepatic and perisplenic fluid collection measuring 10x 17.6x 20 cm, necessitating US-guided percutaneous drainage. Turbid yellow fluid was drained, confirming that the collection was a biloma related to the bile leak. Four weeks later, the percutaneous drain was removed after the collection resolved. Repeated ERCP showed no biliary leak. Discussion: In our patient, the localized xanthoderma post laparoscopic cholecystectomy was secondary to bile leakage from the cystic duct stump. In a similar case report, the authors explained that the localized xanthoderma occurred as a result of bile staining of the tissues deep to the membranous layer of the superficial fascia (fascia of Scarpa) after the bile has leaked from the cystic duct through the hepatoduodenal ligament. The management of our patient involved sphincterotomy and bile duct stenting combined with percutaneous drainage of the collections.Figure 1.: A: Localized yellowish discoloration of the anterior abdominal wall. B: An ERCP fluoroscopic image showing contrast leakage near the cystic stump. Table 1. - Laboratory investigations Laboratory test Patient's value Normal range Total bilirubin 49 µmol/L 0-21 Direct bilirubin 47 µmol/L 0-9 AST 287 U/L 0-32 ALT 249 U/L 0-33 Alkaline phosphatase 264 U/L 35-104

Ultrasound-guided percutaneous drainage as an alternative to surgery in treating breast abscesses

Objectives: The aim of this study was to assess whether ultrasound-guided (US-guided) percutaneous drainage of breast abscesses could be used as an alternative to surgery. Methods: We performed a retrospective study. Twenty patients were included in the study who were diagnosed as having a non-specific breast abscess. Eleven patients underwent surgery whereas nine patients were treated with US-guided drainage. Ultrasonographic findings, results of treatment and follow-up were evaluated between the two groups. Results: In the US-guided drainage group, 5 patients were treated with needle aspiration and 4 were treated with catheter drainage. All cases within the needle aspiration group totally recovered. However, one case within the catheter drainage group failed. The total success rate of US-guided drainage was 88.8%. The median follow-up period was 21.0 days in the US-guided drainage group and 45.0 days in the surgical drainage group. There were no statistically significant differences in terms of recovery (p = 0.450) and follow-up periods (p = 0.112) between the surgical drainage and US-guided drainage groups. Conclusions: US-guided percutaneous drainage may be preferred as a first method of choice in treatment of a breast abscess. The most appropriate approach to breast abscess treatment will be possible with a multidisciplinary approach of surgery and radiology.

Breast abscesses in lactating women: evidences for ultrasound-guided percutaneous drainage to avoid surgery.

Surgical incision with drainage remains the first-line therapy recommendation for breast abscesses greater than 5cm. To determine recovery with ultrasound guided (US-guided) procedures for treatment of lactational breast abscesses without surgical incision for drainage. Institutional review board approval and written informed patient consent were obtained for this retrospective study. From May 1, 2009, to June 1, 2018, 92 consecutive women (mean age 30years, range 18-45) with 105 abscesses were treated with oral antibiotics and US-guided percutaneous drainage under local anesthesia. A total number of 202 US-guided procedures were performed. Three techniques were used: needle aspiration (diameter 18 to 14G), pigtail catheter insertion (diameter 5 to 7F), and/or vacuum-assisted biopsy/aspiration (diameter 10G). When using needle aspiration or pigtail catheter, a saline irrigation of the cavity was performed according to pus viscosity. The median diameter of abscesses was 4.5cm (range 1-15), 82/105 (78%) were larger than 3cm and 40/105 (38%) larger than 5cm. US-guided management was successful for 101/105 (96%; 95% CI, (91-99%)) abscesses regardless the size. After the first round of procedures, 49/105 (47%) abscesses were recovered, 56/105 (53%) needed more than one drainage with a median number drainages of 2.6 (2-6). In 4/105 cases (4%), women underwent additional surgery under general anesthesia. By excluding abscesses which occurred in the weaning phase (n = 17), breastfeeding carried on for 68/75 (91%) women. Unlike previous studies, US percutaneous guided management of lactational abscesses is effective even for abscesses greater than 5cm and allows continued breastfeeding.

Status of Laparoscopic Sleeve Gastrectomy in China: A National Survey.

Laparoscopic sleeve gastrectomy (LSG) is a favorable bariatric procedure. This study evaluated the status of LSG in China. During the 4th International Forum of Bariatric and Metabolic Surgery in May 2016, Nanjing China, an on-the-spot questionnaire was filled out by 105 attending surgeons with experience of LSG. The feedback data was collected and analyzed. For preoperative preparations, surgeons preferred blood glucose control with insulin (61.0%), bowel cleaning (33.3%), and fasting and water deprivation (75.2%). For surgical techniques, surgeons preferred 36/38F bougie (86.7%), greater curvature mobilization with ultrasonic energy device (89.5%), direct transection of short gastric vessels (80%), antrum resection within 2-6cm to the pylorus (84.8%) with 4.8mm height stapler (72.4%), and 3.5mm for corpus (94.3%). Whole stapler-line reinforcement, gastric sleeve fixation, leaking test, and abdominal drainage were preferred by 48.6, 62.9, 39, and 47.6% surgeons. For postoperative managements, surgeons preferred nasogastric tube insertion (33.3%), early liquid diet (69.6%), 4weeks of liquid diet (55.2%), 2000ml daily water intake before discharge (79%), 4weeks of PPI (69.5%), and multi-vitamin supplementation 1 week after operation (77.1%). For postoperative complications, preferences were tachycardia as the onset of leak (81.0%) and oral contrast radiography for leak diagnosis (72.4%). Leak managements include US-guided percutaneous drainage (68.6%), nasogastric tube (87.6%), and parenteral nutrition (61%). For prolonged leak, enteral nutrition (87.6%) and Roux-en-Y bypass (84.8%) as the salvage procedure were preferred. 95.2% preferred endoscopic dilation for stricture. LSG is gaining its wide application in China, but standardization of LSG is urgently needed.

Immediate operation versus percutaneous drainage for treatment of appendicular abscess

AimThis study aims to compare the outcomes, morbidity and hospital stay in patients who underwent emergency surgery, and those who underwent percutaneous drainage for treatment of appendicular abscess. Patients and methodsFrom April 2013 to October 2014, we recruited 40 patients with appendicular abscesses for this study. These patients were randomized into two groups: group 1 (20 patients) for emergency surgery and group 2 (20 patients) for percutaneous drainage. Preoperative data, hospital stay, functional recovery and postoperative complications were analyzed. ResultsFunctional recovery was 2.2±1days in group 1 and 1±0day in group 2. Hospital stay in group 1 was 7.7±3.5days and in group 2 was 4±1days. Postoperative complications in group 1 were noted in 8 (40%) patients. No complications were recorded in group 2. ConclusionsAppendicular abscesses may be safely and effectively treated by US-guided percutaneous drainage with high technical and clinical success rates, low incidence of complications and shorter hospital stay.

An Increasing Prominent Disease ofKlebsiella pneumoniaeLiver Abscess: Etiology, Diagnosis, and Treatment

Background. During the past two decades, Klebsiella pneumoniae (K. pneumoniae) had surpassed Escherichia coli (E. coli) as the predominant isolate from patients with pyogenic liver abscess (PLA) in Asian countries, the United States, and Europe, and it tended to spread globally. Since the clinical symptom is atypical, the accurate and effective diagnosis and treatment of K. pneumoniae liver abscesses (KLAs) are very necessary. Methods. Here, we have comprehensively clarified the epidemiology and pathogenesis of KLA, put emphases on the clinical presentations especially the characteristic radiographic findings of KLA, and thoroughly elucidated the most effective antibiotic strategy of KLA. Results. K1 serotype is strongly associated with KLA especially in diabetic patients. Computed tomography (CT) and ultrasound (US) were two main diagnostic methods of KLA in the past. Most of KLAs have solitary, septal lobular abscesses in the right lobe of liver, and they are mainly monomicrobial. Broad-spectrum antibiotics combined with the US-guided percutaneous drainage of liver abscesses can increase their survival rates, but surgical intervention still has its irreplaceable position. Conclusion. The imaging features contribute to the early diagnosis, and the percutaneous intervention combined with an aminoglycoside plus either an extended-spectrum betalactam or a second- or third-generation cephalosporin is a timely and effective treatment of KLA.

Iliopsoas abscess in the neonate with immunodeficiency

Psoas abscess is uncommon in childhood. It has an insidious onset, and diagnosis and management may be delayed because of non-specific symptoms and signs. A 12-day-old male infant was referred to hospital with skin abscesses and fever. He was born at 39 weeks gestation as the first child of consanguineous parents. His birthweight was 2600 g and there was no history of premature rupture of membranes or maternal fever. His maternal uncle died at 20 days of age due to an unknown cause. On admission, he had a 3 ¥ 3 cm swelling on the medial side of his left ankle, a 0.5 ¥ 0.5 cm swelling on his left hand and a nodule on the lateral side of the left ankle. Laboratory findings were as follows: leukocyte count 26 900/ mm (62% neutrophils, 38% lymphocytes); C-reactive protein 31.3 mg/dL and erythrocyte sedimentation rate 85 mm/h. The abscesses were drained and vancomycin and ceftazidime were initiated. Culture was positive for methicillin-susceptible Staphylococcus aureus. On the seventh day of admission, fever of 38.5°C and swelling and hyperemia on the right groin appeared. On ultrasonography (US) 10–14 mm hypoechoic fluid was seen on the right side of the bladder. Tuberculin skin test, salmonella, brucella, and HIV were negative. Magnetic resonance imaging (MRI) of the abdomen showed an 38 ¥ 16 ¥ 14 mm abscess formation with ring enhancement on the right inguinal region. The patient underwent percutaneous drainage but the drainage material contained very few polymorphonuclear leukocytes without microbiological growth. Antibiotic treatment was continued and follow-up US showed complete resolution of the abscess. On immunological work up, serum immunoglobulins and lymphocyte subset analysis were in the normal range according to age (Table 1). Phagocytic cell functions were also normal on nitroblue-tetrazolium (NBT) slide test. Flow cytometry results were as follows: CD18, 16%; CD11a + CD18, 17%; CD11b + CD18, 3%; CD11c + CD18, 4%. Neutrophil function was determined as 1.89 oxidative explosion, 1.63 phagocytosis and 1.43 chemotaxis (normal, >1.5). Antibiotic prophylaxis was initiated and bone marrow transplantation was recommended. Diagnosis of psoas abscess is difficult in neonates because of the rarity of this disease and the difficulty in differentiating this from septic arthritis due to similar clinical findings. Good physical examination is critical for prompt diagnosis. US and computed tomography are the preferred radiological tests for diagnosis. Psoas abscess in children may be primary or, rarely, secondary to an underlying pathology of kidney, cecum, appendix, or terminal ileum on the right side and fever. Neonates and children may have an antecedent or contemporaneous distant cutaneous infection. The causes of psoas abscess have changed in the last decades. In recent years S. aureus has been reported as the causative agent in 80% of primary psoas abscesses. Early drainage with appropriate systemic antibiotic coverage is the ideal treatment. Drainage of the abscess may be done through US-guided percutaneous drainage or surgical drainage. After complete abscess drainage up to 2 weeks of broad spectrum antibiotic treatment should be started pending culture results. Predisposing conditions to primary psoas abscess development are reported to be HIV infection, diabetes, immunosuppression and renal failure. Based on flow cytometry, the present patient was diagnosed with leukocyte adhesion deficiency type 1 (LAD 1; mild type). In conclusion, immunodeficiency syndromes such as LAD should be investigated in newborns with psoas abscess. The present case is important to emphasize underlying factors in the pathogenesis of psoas abscess.

Diagnosis and subsequent US-guided percutaneous drainage of an adrenal abscess in a 5-week-old infant

Adrenal abscess is an uncommon finding in neonates and young infants. It may have a fatal outcome if inadequately treated. This case report describes the successful diagnosis and treatment of a left-sided adrenal abscess in a 5-week-old girl. Abdominal US and antigranulocyte antibody-scintigraphy showed an encapsulated suprarenal mass with debris suspicious for an adrenal abscess. Treatment is generally surgical. In this case, however, we performed US-guided percutaneous drainage combined with intravenous antibiotic treatment. The child recovered fully.

Isolated Hepatic Tuberculous Abscess in a Renal Transplant Recipient

Tuberculous liver abscess is rare worldwide. We report a 26-year-old renal transplant recipient who presented with fever, fatigue, and weight loss. Ultrasound (US) of the abdomen showed a cystic mass of 7 × 6 cm in the subcapsular region of right liver lobe. US-guided percutaneous drainage was performed and 100 mL of yellow-colored pus was aspirated. The patient was empirically started on ampicillin sulbactam treatment. Despite this treatment, the symptoms persisted. Subsequent control abdominal US showed the persistence of a cystic mass of 7 × 6 cm with thin septation in the subcapsular region near the right liver lobe, which were subsequently diagnosed as a focal hepatic tuberculous abscess by positive culture in Löwenstein-Jensen medium. He was concomitantly started on systemic antituberculous therapy. A tuberculous liver abscess must be considered in the differential diagnosis. Percutaneous drainage along with systemic antituberculous chemotherapy must be considered as an alternative to surgery for the management. A greater awareness of this clinical entity is required for successful treatment.

Liver abscess

A 54-year-old man presented with epigastric pain of 4 weeks' duration. There was tenderness to palpation in the epigastrium. EGD revealed an erosion with surrounding submucosal edema on the lesser curve of the mid gastric body (A, arrow). The patient was hospitalized the next day because of fever (39.3°C). The white blood cell count was 13.0×109/L (normal: 4-9×109/L), and total bilirubin was 3.6 mg/dL (0.2-1.2 mg/dL). US demonstrated a 2×3×4-cm hypoechoic lesion with an associated linear hyperechoic structure 1.5 cm in length in the left lateral segment of the liver (B, arrow). CT confirmed the diagnosis of liver abscess associated with a linear calcified foreign body (C, arrow). After US-guided percutaneous drainage of the abscess, imipenem/cilastatin were administered intravenously. Culture of the abscess fluid grew Streptococcus constellatus. The patient became afebrile, but US still demonstrated the foreign body. At laparotomy, the abscess was resected and was found to contain a 10-mm foreign body, consistent with a fish bone (D). The patient, who recovered uneventfully, recalled that he had eaten small fish whole a month earlier. View Large Image Figure Viewer View Large Image Figure Viewer View Large Image Figure Viewer

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

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.

Splenic abscess: sonographic diagnosis and percutaneous drainage or aspiration.

During a recent 5-year period, 12 patients with splenic abscesses were evaluated by abdominal ultrasound (US) examination. Multifocal abscesses were noted in seven patients, three of them were secondary to infectious endocarditis, three were in immunosuppressed state, and one was caused by tuberculosis. The latter four patients had developed splenic microabscesses with a diameter of less than 1.5 cm. The larger abscesses showed an irregular wall, weak or no internal echoes, ovoid or round in shape, and accompanied by mild to moderate distal acoustic enhancement. Wedge-shaped abscesses were typically noted in patients with infectious endocarditis and septic embolism. US-guided percutaneous drainage was done in five patients (abscesses greater than 4 cm). Simple aspiration in conjunction with antibiotic administration was done for seven smaller abscesses (diameter less than 3.5 cm) in five patients. A second drainage, either for a dislodged catheter or a recurrent abscess, was performed in two cases. All patients had uneventful clinical course following this therapeutic approach.

Pancreatic disorders in infancy and childhood: Experience with 92 cases

Ninety-two children with pancreatic disorders were treated over a 10-year period. Thirty-three had blunt trauma, while 69 had medical, metabolic, or neoplastic diseases. Children with trauma had either duct disruption (3), gland fracture (4), or pseudocysts formation (26). Operation was required in 30. Pseudocysts were treated with observation alone in three cases, ultrasound-guided percutaneous aspiration in three, surgical external drainage in two, distal pancreatectomy in four, cyst gastrostomy in ten, and cyst-Roux-en-Y jejunostomy in six. Other disorders included pancreatitis (44), neoplasms (10), nesidioblastosis (4), and pancreaticosplenic abscess (2). Treatment for neoplasms included surgical excision in nine and biopsy in one (adenocarcinoma). Patients with nesidioblastosis underwent 95% (near total) pancreatic resection (two after previous unsuccessful 80% resection). Pancreatitis was familial in two cases, necrotizing in two, idiopathic in 11, and secondary to medications in six cases (steroids, 2; L-asparaginase, 4), gallstones in 17, and choledochal cysts in 6. Pancreatitis resolved after observation and conservative therapy in ten idiopathic cases, 4/6 medication-related cases, and following correction of biliary tract disease (15/17) or choledochal cysts (6). Pancreatic resection or drainage was required in the remaining cases. Pancreatic disorders can be accurately detected with computed tomography (CT) scan in most cases (excluding insulinoma). Ultrasound (US) is useful in cases of biliary tract disease and pseudocyst formation. Traumatic pseudocysts can resolve spontaneously or with US-guided percutaneous drainage (in the presence of normal ducts). Children with neoplasms, abnormal pancreatic ducts, or recurrent pancreatitis require resection or appropriate drainage procedures. Overall survival was 95%.