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An alternative approach to pyogenic hepatic abscess in childhood
K W Liu1, R J Fitzgerald, N S Blake
1Department of Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
Insights
Childhood pyogenic hepatic abscess is a rare condition. Early diagnosis via ultrasound and percutaneous catheter drainage with antibiotics offer effective treatment for pediatric liver abscess.
Area of Science:
- Pediatric Surgery
- Hepatology
- Diagnostic Imaging
Background:
- Childhood pyogenic hepatic abscess is a rare clinical entity.
- Diagnosis can be challenging due to non-specific symptoms.
- Predisposing factors include chronic granulomatous disease, appendicitis, and abdominal surgery.
Purpose of the Study:
- To review cases of childhood pyogenic hepatic abscess.
- To evaluate diagnostic methods and treatment outcomes.
- To highlight the utility of ultrasound and percutaneous drainage.
Main Methods:
- Retrospective review of seven cases in six children over 13 years.
- Diagnostic modalities included ultrasound, radionuclide scan, and laparotomy.
- Treatment evolved from transabdominal drainage to ultrasound-guided percutaneous catheter drainage.
Main Results:
- Four cases diagnosed by ultrasound, one by radionuclide scan, two at laparotomy.
- Recurrence observed in one patient 7 years post-initial treatment.
- Percutaneous catheter drainage showed satisfactory results in later cases.
Conclusions:
- A combination of unexplained fever, abdominal tenderness, hepatomegaly, and leukocytosis suggests hepatic abscess.
- Ultrasonography is crucial for early diagnosis.
- Percutaneous catheter drainage combined with antibiotics is an effective treatment strategy.
Abstract:
Childhood pyogenic hepatic abscess is rare and remains a difficult diagnostic problem. Seven cases in six children were treated over a 13 year period. There was a recurrence in one patient 7 years after the first presentation. Four patients had identified predisposing factors, namely, chronic granulomatous disease, acute appendicitis, previous abdominal surgery and umbilical vein catheterization, while the other two were cryptogenic. There were no specific symptoms and signs but the combination of unexplained pyrexia, upper abdominal tenderness, hepatomegaly and leucocytosis should raise the suspicion of hepatic abscess. Four cases were diagnosed by ultrasound, one by radionuclide scan and the other two at laparotomy. Treatment in the earlier years was by transabdominal drainage. In the later part of the series, percutaneous catheter drainage using ultrasound guidance was achieved with satisfactory result. Ultrasonography can provide an early diagnosis and effective treatment can be achieved with percutaneous catheter drainage in combination with appropriate antibiotic therapy.