P1471 - Safety and Efficacy of EUS-Guided Trans-Rectal Drainage of Deep Pelvic Abcesses in Children

Christopher A. Bouvette, MD¹, Rachel L. Davis, MD¹, Jalal Gondal, MD¹, Taha Khan, MD², Alessandra Landmann, MD¹, Amir Rumman, MD^1
1University of Oklahoma College of Medicine, Oklahoma City, OK; ²University of Oklahoma Health Sciences Center, Oklahoma City, OK

Introduction: Deep pelvic abscesses (DPA) are usually managed with either percutaneous drainage or surgical washout and drainage. In children, DPAs most commonly occur due to acute appendicitis. Trans-rectal drainage of DPAs has been described in adult patients as a minimally invasive alternative to percutaneous or surgical drainage. The technical feasibility, safety and effectiveness of this technique in children remains unclear.

Methods: In this single-center, single-operator retrospective case series, we analyzed the safety and effectiveness of transrectal drainage of DPAs in patients under 18 years old. DPAs were defined as radiographically evident loculated fluid collections within the pelvic brim with concomitant systemic toxicity (fever, leukocytosis, and/or hypotension).

Results: A total of six patient were included (mean age 12 years, 3/6 males). The etiology of abscess was perforated appendicitis in five patients, and penetrating gunshot wound with bowel injury in one patient. In all patients, percutaneous drainage was deemed to be infeasible due to proximity to pelvic structures. The mean abscess dimensions as determined on computed tomography (CT) were 59 x 45mm. Trans-rectal endosonography was performed using a curvilinear array echoendoscope under deep sedation with propofol, after administration of a magnesium citrate enema. Transrectal drainage was performed successfully in five patients using an electrocautery enhanced 10 x 10mm lumen-opposing metal stent (LAMS). One patient had no safe window for transrectal drainage owing to interposed small bowel and was managed with surgical drainage (technical success 5/6, 83.3%). The LAMS remained in place until radiographic resolution of abscess (mean duration 30 days, range 15-43), then removed endoscopically. Post-procedure antibiotics were given for a total of 10 days. All patients had complete resolution without recurrence (mean follow up time 164 days, range 47-265 days). There were no peri- or post-procedural complications.

Discussion: EUS-guided trans-rectal drainage of DPAs in children appears to be technically feasible, safe and effective. This technique may offer a less invasive alternative to percutaneous or surgical drainage and may be a reasonable salvage option in cases were percutaneous drainage is infeasible.



Disclosures:


Christopher A. Bouvette, MD¹, Rachel L. Davis, MD¹, Jalal Gondal, MD¹, Taha Khan, MD², Alessandra Landmann, MD¹, Amir Rumman, MD¹. P1471 - Safety and Efficacy of EUS-Guided Trans-Rectal Drainage of Deep Pelvic Abcesses in Children, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.