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Complicated appendiceal inflammatory disease in children: pylephlebitis and liver abscess
T L Slovis1, J O Haller, H L Cohen
1Department of Radiology, Children's Hospital of Michigan, Detroit 48201.
Insights
Complicated appendiceal inflammatory disease in children can lead to serious complications like liver abscess and portal vein inflammation. Early recognition by radiologists is crucial for timely diagnosis and treatment.
Area of Science:
- Pediatric Gastroenterology
- Abdominal Imaging
- Infectious Diseases
Background:
- Appendiceal inflammatory disease (AID) can present with nonspecific symptoms in children.
- Complicated AID may involve extra-appendiceal manifestations, including hepatic and vascular complications.
- The spectrum of complications and their diagnostic challenges in pediatric populations warrant further investigation.
Purpose of the Study:
- To report on five pediatric cases of complicated appendiceal inflammatory disease.
- To highlight the association between complicated AID and hepatic abscess or portal vein inflammation.
- To emphasize the radiologist's role in identifying these complications and suggesting the underlying appendiceal etiology.
Main Methods:
- Retrospective case series of five children diagnosed with complicated appendiceal inflammatory disease.
- Review of clinical presentations, imaging findings (ultrasound and computed tomography), and treatment outcomes.
- Analysis of the relationship between appendiceal disease and subsequent liver or portal vein pathology.
Main Results:
- Three of the five children presented with hepatic abscess.
- Two of the five children had inflammation of the portal vein.
- One child developed symptomatic portal hypertension 10 years after the initial appendiceal disease.
- Nonspecific signs and symptoms were common at presentation.
- Radiological findings such as focal liver masses or low-attenuation areas suggested hepatic abscess; portal vein thrombosis or hypertension suggested complicated AID.
Conclusions:
- Complicated appendiceal inflammatory disease in children can manifest with severe hepatic and portal venous complications.
- Radiological findings are key to suspecting complicated AID, even with nonspecific initial symptoms.
- Early and accurate diagnosis by radiologists is essential for appropriate management and to prevent long-term sequelae like portal hypertension.
Abstract:
Five children with complicated appendiceal inflammatory disease are reported. They presented with nonspecific signs and symptoms, but three had liver abscess and two had inflammation of the portal vein. The inflamed portal vein may act as a conduit to the liver for bacteria, or it may become thrombosed and cause portal hypertension and hypersplenism. In one child, symptomatic portal hypertension developed 10 years after the initial disease. In children, an ultrasonic finding of a focal liver mass of low-to-mixed echogenicity or the presence of low-attenuation areas on computed tomographic scans should suggest the possibility of a hepatic abscess, and the radiologist has a major role in suggesting complicated inflammatory disease of the appendix as the cause. Similarly, when portal vein thrombosis or portal hypertension are found, the radiologist should consider complicated inflammatory disease of the appendix as the cause.