Management of Liver Abscess in Children: Our Experience

Abstract

Introduction:Liver abscess is common in pediatric population in India. Children have unique set of predisposing factors and clinical features. Liver abscesses are infectious, space-occupying lesions in the liver; the two most common abscesses being pyogenic and amebic. Its severity depends on the source of the infection and the underlying condition of the patient.Materials and methods:A total of 34 patients less than 12 years were assessed in a retrospective study from January 2012 to 2016. Patients were assessed in terms of age of presentation, etiology, bacteriology, diagnosis, and modality of treatment.Results:The mean age of presentation was 6.3 years. Average volume of abscess was 164 cc. Nine patients (26.4%) underwent percutaneous needle aspiration under ultrasound guidance with wide bore needle (18 G disposable needle). Three patients required more than two sittings of aspiration. Patients with volume more than 80 cc were treated with catheter drainage. Twenty patients (58.8%) underwent ultrasound-guided percutaneous catheter drainage. Two patients required catheter drainage for large abscess and needle aspiration for the smaller abscess.Conclusion:Antimicrobial therapy along with percutaneous drainage constitutes the mainstay of treatment, whereas open surgical drainage should be reserved for selected cases.How to cite this article: Waghmare M, Shah H, Tiwari C, Khedkar K, Gandhi S. Management of Liver Abscess in Children: Our Experience. Euroasian J Hepato-Gastroenterol 2017;7(1):23-26.

Pediatric Liver Abscess: Trends in the Incidence, Etiology, and Outcomes Based on 20-Years of Experience at a Tertiary Center

“…Nevertheless, ultrasonography is still recommended as the mainstay screening modality owing to lower cost, lack of radiation, and non-invasive properties (3). The right-lobe and solitary-lesion preponderance observed in our cases resembled prior studies, except a UK study found that 86.6% (13/15) of cases developed multiple or multiloculated abscesses (2,9,14,17,19). The mean size of the largest diameter abcess (5.3 ± 3.5 cm) among our cases was smaller, compared with prior reports in southern Taiwan (6.9), central Taiwan (6.6), and Côte-d'Ivoire (11.8) (3,9,10).…”

“…The positive abscess culture rates were 19.2% (5/26), 23.5% (8/34), 50% (8/16), 67% (10/15), 73/3% (11/15), and 85.7% (12/14) in studies from the Côte-d'Ivoire, India, Iran, UK, southern Taiwan, and central Taiwan, respectively. The positive blood culture rate appeared lower in general compared to previous studies, such as 13.3% (2/15) and 20% (3/15) in southern and central Taiwan (3,9,10,14,16,17). We reported no amebic or culture-proved fungal abscesses.…”

“…Age at diagnosis reported in most studies was close, including 10 years in a UK study and 8 years in an Iranian study (14,16). A few studies conducted in the developing world disclosed a trend of a younger age at diagnosis, such as 6.3 years in west India, 8.1 years in Brazil, and 5.4 years in the Côte d'Ivoire (3,15,17). Earlier and prolonged exposures to a pathogenic source with limited hygiene in these tropical or developing areas were proposed as reasons contributing to this trend of younger occurrence (3,14).…”

“…In our series, all patients presented with an elevated CRP level, yet abnormal liver enzymes or hyperbilirubinemia were found in less than half, which paralleled the relatively scarce occurrence of clinical subjective jaundice. An Indian study (n = 34) described no abnormal liver function tests and no one suffered from clinical icterus (17). Among patients encountering the chemotherapyrelated neutropenic phase, leukocytosis was even less valuable as a laboratory predictor, while neutropenia has been documented as a predictor.…”

“…We reported no amebic or culture-proved fungal abscesses. Amebic liver abscesses (ALAs) are uncommon in children, with occurrence influenced mostly by endemic factors (17). The reported incidence of ALAs for children varies, such as 7% (1/15), 30% (9/30), 35% (9/26), and 50% (10/20) from studies in Taiwan, Côte-d'Ivoire, Senegal, and Spain (3,9,19,34).…”