Abdominal surgery (first of three parts)

Transgluteal Approach for Draining Pelvic Fluid Collections in Pediatric Patients

PURPOSE

To evaluate a transgluteal approach for draining pelvic fluid collections in pediatric patients.

MATERIALS AND METHODS

Institutional review board approval and informed consent for interventional procedures were obtained. From September 1995 to December 2002, 140 abdominopelvic fluid collections were drained at two institutions. Retrospective analysis of a prospectively gathered procedural database revealed that a transgluteal approach was used to drain 53 of these 140 collections (38%) in 51 patients (29 female, 22 male; mean age, 11.2 years; age range, 0.2-19 years). All patients received antibiotics before the procedure. A retrospective analysis was conducted of the patients' medical records and diagnostic imaging and interventional procedure findings, including the reason for referral; location, volume, and character of collections; method and equipment used for evacuation; duration of therapy; evidence of complications; results of microbiologic examination of specimens; and success rates.

RESULTS

Transgluteal drainage was performed with computed tomographic (CT) guidance in 45 of the 53 collections (85%), with fluoroscopic guidance in three (6%), and with a combination of both modalities in five (9%). A drainage catheter was successfully placed in 49 collections; four small collections were aspirated without drain placement. Infected fluid was obtained from 41 collections, and serosanguineous fluid was obtained from 12 collections. The mean volume aspirated was 80 mL (2-600 mL). A positive culture was obtained at 28 of the 53 procedures. The mean duration of catheter placement was 4 days (range, 2-14 days). There were no major complications.

CONCLUSION

The transgluteal approach to the drainage of abdominopelvic fluid collections with imaging guidance is safe and effective.