Local Complications after Intramuscular Injections in the Buttock in Children

ABSTRACT

Intramuscular injection is a commonly used route of parenteral drug administration. Many types of complications following intramuscular injection into the gluteal muscles have been described. A retrospective review of 32 patients requiring surgical treatment for local compli-caations of the buttock injections in children was made at the Taegu Fatima Hospital from March 1990 to December 1997. Local complications consisted of acute inflammatory compli-cations including cellulitis and abscess (71.9%), fat necrosis (21.9%), and injection granu-loma (6.2%). Over the half of complications were situated in the upper outer quadrant of the buttock but the other 43.7% of them were in the upper inner or lower outer quadrant which were unsuitable sites for intramuscular injection. And the majority of complications were de-veloped within fat tissue (90.6%) rather than within muscle (9.4%). Two thirds of the patients were under 2 years of age, which suggested that there were some difficulties in accurate intra-muscular injection in small children who had smaller muscle masses compared with subcuta-neous fat and were irritable during injection. In patients with abscess, Staphylococcus aureus was the predominant organism, isolated in 84.6% of the patients. The treatment consisted of needle aspiration, incision and drainage or curettage, and surgical excision. In conclusion, we think that the major factor contributing development of complications following intramuscular injection in the buttock was inadvertent intrafat injection instead of intramuscular injection. In order to prevent those complications, it is necessary to inject accurately into the muscle with a knowledge of pelvic anatomy and complications associated with intramuscular injection.