Gastrointestinal Fistulization in Amebic Liver Abscess

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.