Complex Hepatic Abscess in a Child Following Esophageal Procedures: Clinical Insights and Management

Area of Science:

• Pediatric Gastroenterology
• Infectious Diseases
• Surgical Complications

Background:

• Caustic ingestion in children can lead to esophageal strictures requiring repeated interventions like balloon dilation and stenting.
• Esophageal interventions, particularly multiple procedures, carry a risk of iatrogenic complications.
• Hepatic abscess is a rare but serious complication that can arise from bacterial translocation.

Observation:

• A five-year-old girl developed a hepatic abscess following multiple esophageal balloon dilations and stenting for caustic-induced strictures.
• Clinical presentation included abdominal pain, fever, and anorexia.
• Imaging confirmed a complex hepatic abscess, with cultures identifying oral bacteria (Eikenella corrodens, Prevotella oralis).

Findings:

• Bacterial translocation from oral flora to the liver is a likely mechanism for abscess formation after esophageal mucosal disruption.
• Initial antibiotic treatment (ceftriaxone and metronidazole) showed improvement, but fever recurred upon switching antibiotics.
• The patient recovered with a return to the original antibiotic regimen and continued treatment.

Implications:

• This case emphasizes the potential for severe infectious complications following esophageal interventions in pediatric patients.
• Prophylactic antibiotics should be considered for high-risk pediatric patients undergoing repeated esophageal procedures.
• Effective management requires both appropriate antibiotic therapy and source control for hepatic abscesses.