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Protocol-based management of 154 cases of pediatric liver abscess
Subhasis Roy Choudhury1, Niyaz Ahmed Khan2, Rahul Saxena2
1Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, 110001, India. roychouin@yahoo.co.in.
Insights
This study evaluated a protocol for pediatric liver abscess (LA) management. A standardized approach using imaging and interventions like aspiration or drainage resulted in favorable outcomes for most children.
Area of Science:
- Pediatric Hepatology
- Infectious Diseases
- Surgical Management
Background:
- Liver abscess (LA) is a significant global health concern, particularly in developing nations.
- There is a notable lack of established management protocols for pediatric liver abscesses.
- This study addresses the need for evidence-based guidelines in managing pediatric LA.
Purpose of the Study:
- To analyze the outcomes of a standardized, protocol-based management strategy for pediatric liver abscesses.
- To evaluate the effectiveness of different treatment modalities within a defined protocol.
- To provide data on the efficacy and safety of pediatric LA management.
Main Methods:
- Prospective observational study in a tertiary pediatric hospital over 5 years.
- Inclusion of 154 pediatric patients with liver abscess managed under a standardized protocol.
- Treatment stratification based on abscess characteristics: antimicrobial therapy, ultrasound-guided percutaneous needle aspiration (PNA), percutaneous drainage (PCD), and open surgical drainage (OSD).
Main Results:
- Protocol-based management was successful in most cases, with PNA being the most common intervention (49.3%).
- Medical management alone, PNA, PCD, and OSD achieved success rates of 24.6%, 49.3%, 7.14%, and 18.8%, respectively.
- Mortality was low (3.8%), primarily due to sepsis and multi-organ failure; most patients showed good recovery.
Conclusions:
- Ultrasound is a valuable tool for diagnosing, monitoring, and guiding the management of pediatric liver abscesses.
- A standardized protocol for pediatric liver abscess management leads to favorable clinical outcomes.
- The study supports the implementation of protocol-driven care for pediatric liver abscesses.
Aim:
Although liver abscess (LA) is prevalent worldwide, especially in developing countries, there is a paucity of data regarding the protocol for management of LA in children. The aim of this study was to analyze the outcome of a protocol-based management of pediatric LA from a single institution.
Materials And Methods:
This prospective observational study was conducted in a tertiary-care children's hospital and included all patients with LA managed over a 5-year period. Detailed clinical, laboratory, microbiological and imaging parameters were recorded, and the patients were treated according to a standardized management protocol. Small abscesses (<5 cm) and those with solid appearance on initial ultra-sonogram (US) were managed with antimicrobial therapy alone. Liquefied abscesses on imaging were additionally subjected to US guided percutaneous needle aspirations (PNA). Large abscesses pointing to the surface were treated by percutaneous drainage (PCD). Ruptured LA, abscess inaccessible to image-guided drainage and those not responding to other modes of treatment were subjected to open surgical drainage (OSD). Pleural collections were treated by aspirations or intercostal tube drainage. Outcome was analyzed in terms of duration of recovery and complications including mortality.
Results:
Over the 5-year period, 154 pediatric LA patients underwent protocol-based management. The mean age of the patients was 6.76 years with the male:female being 1.26:1. Medical management alone, PNA, PCD and OSD were successful in 38 (24.6%), 76 (49.3%), 11 (7.14%) and 29 (18.8%) cases, respectively. Pleural collections developed in 43 (27.9%) patients out of which aspiration/drainage was needed in 24 (55.81%) cases. The mean duration of hospital stay was 20.67 ± 9.52 days. Ongoing sepsis and multi-organ failure lead to mortality in 6 (3.8%) cases; rest of the patients were doing well on follow-up.
Conclusion:
Ultra-sonography was useful for the initial diagnosis, monitoring the progress and management of LA in children. The outcome of a protocol-based management of LA in children was favorable.
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