A Case Report of Abscess Formation Type Appendicitis Treated Using Endoscopic Ultrasonography Guided Transrectal Drainage in a 13-year-old Boy

Abstract

A 13-year-old boy presenting with a 6-day history of abdominal pain was diagnosed as having acute enteritis, for which he received medication at a nearby clinic. However, no symptomatic remission was gained, and he presented to our hospital with fever in the 38-39°C range and tenderness in the entire lower abdomen. The abdomen was board like. A computed tomography (CT) revealed perforated appendicitis and an abscess cavity in the pelvis, so we made the diagnosis of abscess formation type appendicitis. As the abscess cavity was located close to the rectum, endoscopic ultrasonography (EUS) guided transrectal drainage was performed, and an external drainage tube was placed inside the abscess cavity. Following treatments with antibiotics and abscess cavity irrigation, the abscess rapidly disappeared. On hospital day 9, the external drainage tube was exchanged to an internal stent, which was spontaneously expelled on hospital day 29.

A laparoscopic interval appendectomy was performed 135 days after the EUS guided transrectal drainage. He was discharged 4 days after the operation without any postoperative morbidity.

We report a case of pediatric abscess formation type appendicitis treated using EUS guided transrectal drainage, with a literature review.