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Figure 2c. Images in a 6-year-old girl who had successfully undergone drainage of multiple abdominopelvic abscesses after perforating appendicitis. (a) CT scan obtained through the pelvis with the patient in a supine position after rectal and intravenous administration of contrast material shows a newly diagnosed low-attenuation fluid collection within an enhancing thick-walled abscess cavity (arrows) in the pouch of Douglas. Contrast material (*) is also seen in the dependent portion of the urinary bladder anterolateral to the abscess. (b) Fluoroscopic image obtained with the patient prone shows the guidewire being advanced with a transgluteal approach into the pelvic fluid collection through a Yueh needle, which was then removed. The needle evident on this image was used for initial access in a tandem-needle technique. Aspiration of grossly purulent fluid helped confirm the location within the abscess cavity. Dilute contrast material from a previous imaging study remains evident in the right ureter and urinary bladder. (c) Fluoroscopic image obtained with the patient prone. The tract was dilated to 9 F and an 8.5-F locking pigtail catheter (arrow) was inserted over the guidewire, which was then withdrawn. Approximately 60 mL of frankly purulent fluid was aspirated. A small amount of contrast material (*) was injected through the catheter to help confirm location within the abscess cavity. Dilute contrast material from a previous imaging study remains evident in the ureters and urinary bladder. The pigtail was locked and the catheter secured to the skin and left to gravity drainage. (d) Follow-up supine CT scan obtained through the pelvis after rectal (*) and intravenous administration of contrast material. The scan was obtained several days after drain insertion and demonstrates the drainage catheter (arrows) in a satisfactory position and interval decompression of the abscess cavity. The drain was removed shortly after this study was obtained, without recurrence of the fluid collection.
