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Percutaneous aspiration versus open drainage of liver abscess in children
Shamsul Bari1, Khurshid Ahmad Sheikh, Ajaz A Malik
1Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India. shamsulbari@rediffmail.com
Insights
Pediatric liver abscesses, particularly those caused by Ascaris, are rare but common in Kashmir. Open drainage remains the most effective treatment, though percutaneous aspiration is a viable alternative requiring expertise.
Area of Science:
- Pediatric Surgery
- Hepatology
- Infectious Diseases
Background:
- Liver abscess is a severe condition rarely encountered in pediatric populations.
- Children affected are often immunocompromised with poor socioeconomic status.
- Ascaris-induced liver abscess is a notable complication in pediatric patients from the Kashmir region.
Purpose of the Study:
- To investigate the incidence, diagnosis, and management of liver abscess in children.
- To compare the efficacy of different treatment modalities for pediatric liver abscess.
Main Methods:
- A retrospective study of 129 pediatric cases (0-14 years) over a 10-year period (1991-2000).
- Diagnosis involved clinical examination, abdominal ultrasonography (USG), and computed tomography (CT).
- Treatment options included antibiotics alone, open surgical drainage, and ultrasound-guided percutaneous aspiration.
Main Results:
- Open drainage was employed in 55 cases, percutaneous aspiration in 27, and antibiotics alone in 49.
- Percutaneous aspiration failed in 5 patients, necessitating subsequent open drainage.
- The right lobe of the liver was the most common site for abscess formation.
Conclusions:
- Open surgical drainage is considered the optimal management for pediatric liver abscess.
- Percutaneous aspiration is a safe and effective alternative but demands significant clinical expertise.
- Early diagnosis using imaging techniques like USG and CT is crucial for effective treatment.
Abstract:
Liver abscess, though a very grave problem, is rarely seen in infancy and childhood. Affected children are usually immunocompromised and are of poor socioeconomic status. Although liver abscess due to wandering ascarids is rare outside, it is common complication among children of Kashmir. Usual site of abscess is the right lobe of the liver and USG and CT of the abdomen are the main tools of diagnosis. The study was conducted over a period of 10 years from January 1991 to December 2000 and total of 129 cases were studied in the age group of 0-14 years. Diagnosis was made by a detailed clinical examination together with USG and CT of the abdomen. Out of 129 cases, 49 were treated with antibiotics alone, 55 cases were taken for open drainage, and 27 cases were taken for percutaneous aspiration under USG guidance. Percutaneous aspiration failed in five patients who were later taken for open drainage. Open method was found still to be the best modality of management, although percutaneous aspiration is safe and effective but needs lot of expertise.
