Conservative initial treatment for liver abscesses in children

Abstract

A total of 124 children aged less than 14 years with a liver abscess were seen in a 16-year period (1974-1990) and treated by non-operative initial management. Of the abscesses 98 occurred in the right liver and 26 in the left. The abscesses were solitary in 93 patients. Overall, 77 of the solitary and 21 of the multiple abscesses were confined to the right liver. In 78 of the right-sided and 20 of the left-sided abscesses the infection was primarily pyogenic in nature with Staphylococcus aureus being the usual organism cultured. The remainder were of amoebic origin. Clinical features were similar in patients with amoebic and pyogenic abscesses. Clinical and ultrasonographic follow-up demonstrated successful non-operative management and healing in 37 per cent of all patients submitted to an initial protocol of medical supportive care and antibiotic therapy. Of the multiple abscesses 60 per cent responded to non-operative management. Fourteen of the 16 solitary left-sided liver abscesses required drainage and three left-sided abscesses ruptured before drainage. Patients with a solitary left-sided abscess warrant early operative intervention.

Liver abscess in children: an overview

“…[21] Causative organism Pyogenic organisms account for nearly 80% of LA in children, followed by amebic LA which is responsible for about 21%-30% of the cases. [1][2][3] Worldwide, the most common pathogen isolated from LA in children is Staphylococcus aureus both in developed and developing countries. [4,22] Studies from India revealed similar results.…”

“…[1][2][3] Studies from the United States suggest that 1%-7% of the population is infected with Entamoeba histolytica and less than 1% of the infected have extraintestinal disease. [28] Fungal hepatic microabscesses either alone or in association with splenic microabscesses may occur in children with leukemia.…”

“…In another study, nonoperative treatment was successful in 60% of cases of multiple LA. [3] A report of 38 children with LA in children from Pakistan concluded that the conservative management was effective for smaller abscesses (<5 cm) and percutaneous needle aspiration under US guidance was the best treatment modality for noncomplicated larger abscesses (>5 cm). [39] However, studies have suggested that 80%-90% of pyogenic LA cases require drainage.…”

“…Good results including a low mortality have been reported. [3] (2) For high, posteriorly located LA, a posterior transpleural approach can be used. It is apparent that a laparoscopic approach may be a useful minimally invasive technique for drainage of LA.…”

“…It was concluded that open surgical drainage was still the best modality of treatment, and that although percutaneous aspiration was safe and effective, expertise was required. [23] Moore et al [3] studied 124 children with LA for a period of 16 years and suggested that patients with a solitary left-sided LA warrant early operation. Other researches have also advocated early surgical treatment of LA in children.…”