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Image-guided abscess drainage in children with perforated appendicitis – can it wait?

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Abstract

Background

Image-guided drainage is the management of choice for perforated appendicitis with intra-abdominal abscess/es. However, there is paucity of data regarding the optimal time for intervention in children.

Objective

The purpose of this study is to assess the relationship between the time from diagnosis of a drainable abscess to abscess drainage (delta time) and the clinical outcome in patients with complicated acute appendicitis.

Materials and methods

This is an institutional review board (IRB)–approved retrospective study comprising 80 pediatric patients who had image-guided abscess drainage due to perforated acute appendicitis. Delta time was associated with clinical outcome including length of stay, catheter dwell time, need for additional interventions, and need for tissue plasminogen activator (t-PA). Gamma regression models were used to assess the adjusted effect of delta time on the “length of stay” and “catheter dwell time” using “volume of the largest abscess” and “number of collections” as severity indices. Logistic regression was used to assess the effect of delta time on the “need for the t-PA” and “need for additional interventions.”

Results

Mean age (SD) was 10.2 (3.8) years. Mean time between diagnosis and intervention (delta time) was 1.5 (1.2) days. There was no evidence that delta time effects the length of stay, catheter dwell time, need for t-PA, and need for additional interventions (P > 0.05). However, there was an association between the number of collections and volume of the largest abscess with length of stay (P = 0.006; P = 0.058), catheter dwell time (P = 0.029; P < 0.001), and need for additional interventions (P = 0.029; P = 0.016).

Conclusions

Our results suggest that time between diagnosis of an appendicitis associated abscess and intervention is not significantly associated with need for tPA, need for additional intervention, drain dwell time, or length of stay.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada

    Maria F. Dien Esquivel & Gali Shapira-Zalstberg

  2. Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Ottawa, ON, Canada

    Maria F. Dien Esquivel

  3. CHEO Research Institute, Ottawa, ON, Canada

    Reza Belaghi & Richard Webster

Authors
  1. Maria F. Dien Esquivel
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  2. Reza Belaghi
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  3. Richard Webster
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  4. Gali Shapira-Zalstberg
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Contributions

M.F.D.E. collected and analyzed the data, interpreted the images, and drafted the initial manuscript.

R.B. performed the statistical analysis.

R.W. contributed to performing the statistical analysis.

G.S.Z. conceived and supervised the study and contributed to writing the manuscript.

All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Maria F. Dien Esquivel.

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Dien Esquivel, M.F., Belaghi, R., Webster, R. et al. Image-guided abscess drainage in children with perforated appendicitis – can it wait?. Pediatr Radiol 53, 2229–2234 (2023). https://doi.org/10.1007/s00247-023-05726-2

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  • DOI: https://doi.org/10.1007/s00247-023-05726-2

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