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Gastrointestinal Fistulization in Amebic Liver Abscess
K P Srikanth1, B R Thapa, Sadhna B Lal
1Division of Pediatric Gastroenterology, Department of Gastroenterology, PGIMER, Chandigarh, India. Correspondence to: Dr KP Srikant, Senior Resident, Division of Pediatric Gastroenterology, Department of Gastroenterology, PGIMER, Chandigarh, India. kpkantha@gmail.com.
Insights
Amebic liver abscess in children can rarely involve gastrointestinal tract fistulization. Successful management often involves antibiotics and catheter drainage, avoiding surgery.
Area of Science:
- Pediatric infectious diseases
- Hepatology
- Gastroenterology
Background:
- Liver abscess is a frequent deep-seated infection in children.
- Amebic liver abscess (ALA) presents a higher risk of local complications compared to other types.
- Gastrointestinal (GI) tract communication is an uncommon but significant complication of ALA.
Observation:
- Two preschool-aged children presented with acute symptoms including fever and right upper quadrant pain.
- Diagnostic imaging revealed liver abscesses with direct communication to the GI tract: ascending colon in one case and duodenum in the other.
- Diagnosis of amebic liver abscess was confirmed via DNA PCR, highlighting the causative agent.
Findings:
- Both pediatric patients were successfully treated with a conservative approach.
- Management included intravenous antibiotics and percutaneous catheter drainage of the abscess.
- No surgical intervention was required for either case.
Implications:
- This case series suggests that gastrointestinal fistulization, though rare, can occur in pediatric amebic liver abscess.
- Conservative management, comprising antibiotics, catheter drainage, and supportive care, appears effective for such complex cases.
- Highlights the importance of considering and managing ALA with GI communication non-surgically when feasible.
Background:
Liver abscess is a common deep seated abscess in children; amebic liver abscess is associated with more local complications.
Case Characteristics:
We report two preschool children presenting with short history of pain, fever and right upper quadrant pain. The abscess communicated with gastro-intestinal tract (ascending colon in case 1 and duodenum in case 2), and diagnosis of amebic liver abscess was confirmed by DNA PCR.
Outcome:
Both children were successfully managed with intravenous antibiotics and catheter drainage.
Message:
Gastrointestinal fistulization may be rarely seen in amebic liver abscess. Conservative management with antibiotics, catheter drainage and supportive care may suffice.
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