Intra-abdominal abscesses in children : the usual and the unusual

Abstract EN

Backgrounds: Abscesses due to complicated appendicitis as well as post appendectomy? abscesses are the most common intra-abdominal abscesses in children (IAA).

Nevertheless, rare pathologies must be ruled out.

Objectives: To study the experience with intra-abdominal abscesses (IAA) in children at the American University Hospital, in terms of presentation, diagnosis and management.

Methods: All cases of IAA in children that were managed at the American University of Beirut Medical Center were collected for a period of five years.

The different presentations and management were reviewed for analysis.

Results : Eight cases of IAA in children were reviewed.

Four abscesses were appendix related from a total of 123 appendectomies done during this period: two were appendiceal abscesses, and two were post appendectomy abscesses.

The remaining four had unusual underlying pathologies: Meckel's diverticulum masquerading as post- appendectomy abscess, tuberculous abscess with jejunal perforation treated elsewhere as a case of suspected typhoid fever, infected mesenteric cyst with abscess mimicking complicated appendicitis, and splenic with subphrenic abscess secondary to hematogenous spread from an indolent infected aortic Dacron graft.

Percutaneous drainage was attempted in three of the four unusual cases but was not successful.

Conclusion: Although complicated appendicitis is a common cause of IAA in children, failure of percutaneous drainage should alert the physician to other underlying pathologies requiring urgent exploration.