Pediatric pyosalpinx without sexually transmitted infection: A report of 3 cases.

Pelvic inflammatory disease commonly occurs in adults and is most frequently caused by sexually-transmitted organisms. When left untreated, it can progress to abscess formation and subsequent infertility due to tubal scarring. This condition rarely occurs in the pediatric population and even less frequently in the absence of sexual activity. The cases presented here depict 3 cases of pyosalpinx due to noncommunicable infectious agents. Since children are typically not subjected to transvaginal ultrasound, they are particularly at risk for delays in diagnosis and appropriate treatment. Cases described here also demonstrate the value of the pediatric interventional radiology service in treating this gynecological source of infection. Both transabdominal and transrectal approached to ultrasound-guided drainage are described.

Canal of Nuck hernias.

The canal of Nuck, caused by the failed closure of the processus vaginalis in the female, is the continued outpouching of parietal peritoneum through the inguinal canal to the labia majora. Disorders of the canal of Nuck include hernia and hydrocele. Some canal of Nuck hernias, especially of the ovary, may result in emergent complications such as incarceration, strangulation, and ovarian torsion. Knowledge of canal of Nuck disorders and prompt diagnosis are important to avoid serious complications. Imaging, especially ultrasound, is essential for timely diagnosis, leading to appropriate management and better patient care.

Transrectal ultrasound and fluoroscopy-guided drainage of deep pelvic collections in children.

PURPOSE: Pediatric deep pelvic abscesses generally occur as a complication of perforated appendicitis or after laparoscopic appendectomy. We describe our technique and experience in imaging-guided transrectal drainage (TRD) of deep pelvic abscesses in children. METHODS: From January 2005 to November 2008, imaging-guided TRD was attempted in 29 children. The procedure records and medical records were reviewed retrospectively. RESULTS: Twenty-nine TRD procedures were performed in 17 males and 12 female patients. The mean age was 11.8 years (range, 3.8-15.9 years). Fourteen patients required TRD after an abdominal operative procedure: laparoscopic appendectomy (n = 9), open appendectomy (n = 3), exploratory celiotomy for gunshot wound (n = 1), and exploratory celiotomy with intestinal resection for adhesive bowel obstruction (n = 1). Fifteen patients were referred for TRD as initial therapy for deep pelvic fluid collections: perforated appendicitis (n = 14) and Crohn perforation (n = 1). Twenty-seven (93.1%) procedures were successful, described as either placement of a TRD catheter or aspiration of the deep pelvic fluid using transrectal approach. There were no procedure-related complications. CONCLUSIONS: Imaging-guided TRD in children is a safe and easy procedure that allows drainage of deep pelvic abscesses that are otherwise not easily accessible.