Imaging description

A previously healthy 11-year-old girl presented to interventional radiology with a two-week history of lower abdominal pain and diarrhea without nausea, vomiting, or fever. One week into the course of her present illness, antibiotics were begun empirically when a pediatrician at a neighborhood medical convenience clinic saw the patient. Antibiotics were discontinued two days later when she saw her regular pediatrician. However, as she continued to have pain and subjective fever, the patient’s parents sought medical attention four days later. At that time, the patient’s temperature was 104.2 °F and her white blood cell count was 21 700 with a left shift. An ultrasound scan (Fig. 39.1) demonstrated a large pelvic fluid collection that was drained percutaneously with CT guidance (Fig. 39.2). Following drainage, the patient became afebrile and her leukocytosis resolved. She was discharged from the hospital with instructions on care of her drainage tube. A sinogram/abscessogram was performed two weeks and again five weeks following drainage. Both examinations showed that the abscess cavity had shrunk to the size of the pigtail catheter loop, but a persistent sinus tract leading from the cavity to the terminal ileum was present (Fig. 39.3a). As the patient refused to go to school with the drainage tube in place, it was decided to attempt to close the sinus tract with tissue adhesive (Fig. 39.3b–d). Following treatment, the patient returned to school and resumed other normal activities. However, at six weeks post-treatment, she presented with recurrent abdominal pain, leukocytosis, and fever. CT (Fig. 39.4) demonstrated recurrent appendicitis, and an appendectomy was performed at that time. There have been no problems since.