Use of Tissue Plasminogen Activator in Abdominal Abscesses in Children—A Single-Center Randomized Control Trial

Abstract

Purpose: To establish the efficacy of once-per-day intracavitary tissue plasminogen activator (tPA) in the treatment of pediatric intra-abdominal abscesses. Methods: A single-center prospective, double-blinded, randomized controlled trial of the use of intracavitary tPA in abdominal abscesses in children. Patients were randomized to either tPA-treatment or saline-treatment groups. Primary outcome was drainage catheter dwell (hours). Secondary outcomes were length of hospital stay, times to discharge, clinical and sonographic resolution, and adverse events (AEs). Results: Twenty-eight children were randomized to either group (n = 14 each). Demographics between groups were not significantly different (age P = .28; weight P = .40; gender P = .44). There were significantly more abscesses in the tPA-treated group ( P = .03). Abscesses were secondary to perforated appendicitis (n = 25) or postappendectomy (n = 3). Thirty-four abscesses were drained, 4 aspirated, 3 neither drained/aspirated. There was no significant difference in number of drains ( P = .14), drain size ( P = .19), primary outcome ( P = .077), or secondary outcomes found. No procedural or intervention drug-related AEs occurred. No patient in the saline-treated group required to be switched/treated with tPA. Conclusion: No significant difference in the length of catheter dwell time, procedure time to discharge, or time to resolution was found. Intracavitary tPA was not associated with morbidity or mortality. The results neither support nor negate routine use of tPA in the drainage of intra-abdominal abscess in children. It is possible that a multicentre study with a larger number of patients may answer this question more definitively.

Image-Guided Percutaneous Drainage of Abdominal Abscesses in Pediatric Patients

“…Gibson CR et al, 2021 [61] Randomized controlled trial, with a sample size of 56 pediatric patients.…”

“…For more complex collections, intracavitary tissue plasminogen activator (tPA) with a normal saline solution has been suggested to facilitate drainage; this therapy can be performed as needed or on a set regimen [ 59 , 60 ]. However, a recent study by Gibson et al found no benefits of tPA over a regular saline flush in terms of shorter catheter dwell time, procedure time to discharge, or time to resolution [ 61 ].…”

“…McNeely et al found that large and more diffuse abscesses significantly increase the rate of technical failure [ 69 ]. As mentioned, Gibson et al showed that administering tPA via the drainage catheter did not show any advantage over regular saline flushing [ 61 ].…”