We describe our 6-year experience with an US-guided one-step trocar technique for transrectal abscess drainage in a pediatric population. Although transrectal drainage of pelvic abscesses has been proved effective, the technique described here simplifies the procedure into a single step, minimizing potential injury to the operator and patient and eliminating potential fluoroscopic radiation while maintaining an excellent clinical success rate. Additionally, our technique obviates the need for protective techniques for sharp instrumentation while advancing the needle from the anus through the rectum into the abscess.