REGULAR CONTENT
Final ID
525
Type
Original Scientific Research-Oral or Pos
Authors
Y Zhang1, I Bezahler2, S Maddineni3, P Gerard1, G Stringel1
Institutions
1Westchester Medical Center, Valhalla, NY, 2New York Medical College, Valhalla, NY, 3N/A, Chappaqua, NY
Purpose
Compare the therapeutic and cost-effectiveness of percutaneous drainage in addition to antibiotics versus antibiotics alone in the treatment of periappendiceal abscess among a pediatric population.
Materials & Methods
We conducted a 12 year retrospective chart review of pediatric patients under 18 years of age with acute perforated appendicitis complicated by periappendiceal abscess. Diagnosis was made by CT, US or MRI examination. Appropriate IRB approval was obtained. Group 1 consists of patients who received non-operative management with antibiotics only (n:26). Group 2 consists of patients who underwent percutaneous drainage by the interventional radiology (IR) service and received antibiotics (n:26). 5/26 patients were initially treated with antibiotics and later required IR drainage. Patients' demographics, initial clinical presentation, abscess size and location, length of hospital stay, outcome and complication were compared between the two groups. The technical aspects of catheter placement (transgluteal versus anterior percutaneous approach) and the associated outcomes were also investigated.
Results
5 patients in group 1 failed management with antibiotics alone and required drainage by IR. There were no failures of treatment in group 2. There was no significant difference in mean hospital stay between the two groups (Group 1: 7±3 days; Group 2: 8±4 days). Prolonged hospital stay is frequently associated with small bowel obstruction or ileus at initial presentation in both groups. There were no deaths and no significant long term complications in either group. All patients were eventually managed with interval appendectomy.
Conclusions
Percutaneous drainage of periappendiceal abscess is safe and effective in the pediatric population. Management with antibiotics alone can be successful in a majority of patients, but is insufficient in a small group of patients (16 % failure rate in our group). Both anterior and transgluteal approaches are safe and effective. Transgluteal approach provides accessibility to collections within the deep pelvis not amenable to anterior approach.
Final ID
525
Type
Original Scientific Research-Oral or Pos
Authors
Y Zhang1, I Bezahler2, S Maddineni3, P Gerard1, G Stringel1
Institutions
1Westchester Medical Center, Valhalla, NY, 2New York Medical College, Valhalla, NY, 3N/A, Chappaqua, NY
Purpose
Compare the therapeutic and cost-effectiveness of percutaneous drainage in addition to antibiotics versus antibiotics alone in the treatment of periappendiceal abscess among a pediatric population.
Materials & Methods
We conducted a 12 year retrospective chart review of pediatric patients under 18 years of age with acute perforated appendicitis complicated by periappendiceal abscess. Diagnosis was made by CT, US or MRI examination. Appropriate IRB approval was obtained. Group 1 consists of patients who received non-operative management with antibiotics only (n:26). Group 2 consists of patients who underwent percutaneous drainage by the interventional radiology (IR) service and received antibiotics (n:26). 5/26 patients were initially treated with antibiotics and later required IR drainage. Patients' demographics, initial clinical presentation, abscess size and location, length of hospital stay, outcome and complication were compared between the two groups. The technical aspects of catheter placement (transgluteal versus anterior percutaneous approach) and the associated outcomes were also investigated.
Results
5 patients in group 1 failed management with antibiotics alone and required drainage by IR. There were no failures of treatment in group 2. There was no significant difference in mean hospital stay between the two groups (Group 1: 7±3 days; Group 2: 8±4 days). Prolonged hospital stay is frequently associated with small bowel obstruction or ileus at initial presentation in both groups. There were no deaths and no significant long term complications in either group. All patients were eventually managed with interval appendectomy.
Conclusions
Percutaneous drainage of periappendiceal abscess is safe and effective in the pediatric population. Management with antibiotics alone can be successful in a majority of patients, but is insufficient in a small group of patients (16 % failure rate in our group). Both anterior and transgluteal approaches are safe and effective. Transgluteal approach provides accessibility to collections within the deep pelvis not amenable to anterior approach.