A Pediatric Case of Successful Endoscopic Ultrasound-Guided Transrectal Drainage of a Pelvic Abscess

Abstract

A six-year-old boy was admitted to a family hospital owing to fever, vomiting, diarrhea, and abdominal pain. He was diagnosed as having acute gastroenteritis and treated, but he showed no improvement. He was referred to our department because a marked inflammation and a pelvic abscess were confirmed by abdominal CT. Lower abdominal pain accompanied by peritoneal irritation was observed, and a diagnosis of a pelvic abscess with perforated appendicitis was made on the basis of the CT findings. Because his general condition was maintained, conservative treatment was selected, and endoscopic transrectal drainage was performed on the 9th day after onset because the pelvic abscess was in contact with the rectal wall. The fever disappeared the next day, and abdominal CT on the 12th day after surgery showed that the abscess cavity had almost disappeared, and he was discharged 14 days after surgery. On the 19th day after surgery, part of the stent escaped from the anal margin and was removed endoscopically. There was no recurrence after removal, and laparoscopic appendectomy was performed 3 months later. Although this method has not been reported for children, it is considered to be a minimally invasive and safe procedure in this case, and it may be a useful treatment option.