RESUMO
BACKGROUND: There is limited literature on renal abscesses in children and therefore no consensus on management. The objectives of this study were to describe renal abscesses in a contemporary paediatric Australian population and present a 20 year review of the literature. METHODS: An 11 year retrospective comparative study was conducted of paediatric patients with renal abscesses. A literature review of all eight original articles on paediatric renal abscesses from January 2001 to December 2021 was performed. RESULTS: Fourteen children with a mean age of 11 years were diagnosed with a renal abscess on ultrasound and/or computed tomography. The most common presenting symptoms were fever (n = 13, 93%) and flank or abdominal pain (n = 12, 86%). The most common causative organisms were Staphylococcus aureus (n = 7, 50%) and Escherichia coli (n = 4, 29%). All renal abscesses less than 3 cm were managed with antibiotics alone. Five out of nine abscesses 3-5 cm were managed with percutaenous drainage (56%). Two multi-loculated abscesses greater than 5 cm required open drainage in theatre (100%). CONCLUSIONS: The most common causative organism in the North Queensland population was S. aureus, with a higher incidence of MRSA. This should be taken into consideration when prescribing empirical antibiotics. Most renal abscesses in children that are less than 3 cm in size can be managed with antibiotic therapy only. The evidence for management of larger abscesses is less clear, but where clinically appropriate conservative management with antibiotic therapy should be considered in the first instance, with percutaneous drainage in cases of antibiotic failure.
Assuntos
Abscesso Abdominal , Nefropatias , Infecções Urinárias , Criança , Humanos , Abscesso/diagnóstico , Abscesso/epidemiologia , Abscesso/terapia , Estudos Retrospectivos , Staphylococcus aureus , Austrália/epidemiologia , Abscesso Abdominal/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Drenagem/métodos , Nefropatias/epidemiologia , Nefropatias/terapia , Antibacterianos/uso terapêuticoRESUMO
A retained appendicolith is an uncommon complication that can arise from appendix rupture and can lead to recurrent abscess formation. We present a case of a retained appendicolith causing recurrent infection over a 12-month period in a paediatric patient. The appendicolith migrated to the left side of the abdomen and then through the abdominal wall into the subcutaneous tissues. The appendicolith was finally retrieved in a joint surgical and interventional radiology case using ultrasound guidance.
