Abstract

ABSTRACT:
BACKGROUND:
Acute appendicitis is a common clinical problem with an incidence of approximately 1 case per 1,000 persons per year. Perforation is a common complication of appendiceal inflammation, with an overall incidence of approximately 30% in pediatric populations and as high as 66% in children younger than 5 years and up to 100% in 1-year-olds. Computed tomography (CT)-guided abscess drainage has also been shown to provide definitive treatment for 70–90% of abdominal abscesses
OBJECTIVE:
The aims were to report the role of CT-guided drainage of pelvic collection following acute appendicitis, technical success and possible complications.
PATIENTS AND METHODS:
A prospective study was done in Al-Kadhimyia teaching hospital,between March 2009 and November 2012. The study included 48 consecutive patients with pelvic abscess following appendicectomy for acute appendicitis. Age range was 10–58 years; 26 male, 12 female. All patients underwent sonography and contrast-enhanced abdominal CT was performed to confirm the diagnosis. CT guided drainage with a pigtail multi-sidehole catheter of 12 – 14 French was done. Post-drainage scans were obtained to assess the position of the catheter and to exclude early complications (e.g., hematoma). Catheters were flushed with 10-15 ml of 0.9% sterile saline every 8 hr. to maintain patency.
The decision for catheter removal was based on the following criteria: clinical improvement (normal body temperature and white blood cell (WBC) count, no clinical symptoms), drainage output of 10 mL/d or less, and ultrasound findings of complete resolution of the target fluid collection.
RESULTS:
The study included 48 patients. The depth of the collections was ranged from 4-8cm (mean of 6cm). Of the 48 patients, 40 had single drainage procedure, and 8 returned for a second procedure. The (8/48) necessitated a second drainage procedure (5cases of catheter displacement and 3 cases of catheter obstruction). Treatment failure was seen in 3/48 (6.25%) patients and were treated with surgical drainage. Clinical success of the procedures was (93.75%). The volume of fluid drained ranged from 200 ml to 4,500 ml (mean 440 ml). Fluid culture reveals Escherichia coli in 27%, and Enterococcus spp in 15% and polymicrobial in 58% of cases. hospital stay was 13±6.4 days (8–28 days), while those who underwent two procedures had an average stay of 20.2±6.5 days. No catheter-related wound sepsis was noted at the time of discharge or follow-up, and no catheter tract failed to close spontaneously.
CONCLUSION:
CT _guided drainage of pelvic abscess following acute appendicitis is an effective method of treatment with no catheter-related wound sepsis and no major periprocedural complications.