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Published on: December 4, 2023
Liver abscesses in children: a single center experience in the developed world
1Department of Child Health, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
Insights
Pyogenic liver abscess (PLA) is rare in children and may indicate underlying neutrophil disorders. Prompt treatment with antibiotics and aspiration is effective, but complications like portal hypertension must be monitored.
Area of Science:
- Pediatric Hepatology
- Pediatric Infectious Diseases
- Radiology
Background:
- Pyogenic liver abscess (PLA) is an uncommon diagnosis in pediatric patients in developed countries.
- It can be the initial presentation of underlying conditions such as chronic granulomatous disease (CGD).
Purpose of the Study:
- To investigate the clinical and radiologic features of pediatric pyogenic liver abscess.
- To identify predisposing risk factors and potential complications associated with PLA in children.
- To evaluate treatment outcomes for pediatric PLA.
Main Methods:
- Retrospective analysis of a 10-year database of children referred to a tertiary pediatric hepatology center.
- Case note review of patients with radiologically confirmed pyogenic liver abscess.
Main Results:
- Fifteen children (7 boys) were diagnosed with PLA, representing 0.5% of referrals, with a median age of 10 years.
- Three cases were the first manifestation of chronic granulomatous disease; four developed portal vein thrombosis and portal hypertension.
- Staphylococcus aureus was the most common pathogen; all patients achieved successful outcomes with guided aspiration and intravenous antibiotics.
Conclusions:
- Pediatric PLA is rare and can be linked to primary neutrophil disorders, even without prior infection history.
- Associated conditions like appendicitis and intra-abdominal sepsis require investigation due to risks of portal vein obstruction and hypertension.
- Prolonged intravenous antibiotic therapy tailored to microbial sensitivities is a highly effective treatment strategy.
Objectives:
The aim of this study was to investigate the clinical and radiologic features, predisposing risk factors, and complications of children with pyogenic liver abscess (PLA) referred to a tertiary pediatric hepatology center.
Methods:
We analyzed our database of all children referred to our unit over a 10 year period and performed a case note review of all patients with a radiologically proven PLA.
Results:
PLA was diagnosed in 15 children (7 boys), 0.5% of all referrals. They presented at a median age of 10 years (range 2 months-15 years). In three children (2 boys), PLA was the first manifestation of chronic granulomatous disease. Among the others, five had radiologic evidence of other intra-abdominal pathology (1 with subsequently proven appendicitis), and four developed portal vein thrombosis with portal hypertension. The commonest isolated pathogen was Staphylococcus aureus. Combined treatment with guided aspiration and prolonged intravenous antibiotics was successful in all patients.
Conclusion:
PLA is a rare diagnosis in children in the developed world. It may be caused by primary neutrophil disorders even in the absence of a previous history of infection. Co-existent appendicitis, intra-abdominal sepsis, and ascending pylephlebitis must be sought because these children are at risk of developing portal vein obstruction and portal hypertension. Prolonged intravenous antibiotic treatment guided by microbiologic sensitivities is highly effective.
