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Left-sided liver abscess in childhood
S W Moore1, K Lakhoo, A J Millar
1Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town.
Abstract:
Abscesses occur less frequently on the left side of the liver than on the right, and are implicated in a higher incidence of complications. Of a total of 124 children with liver abscesses seen at Red Cross War Memorial Children's Hospital from 1974 to 1990, 26 had left-sided and 98 right-sided lesions. A similar spectrum of organisms was cultured, and 20 (77%) of the left-sided abscesses were found to be caused by pyogenic organisms as opposed to 78 (79%) of those on the right. The remainder were of amoebic origin. In 5 patients with multiple abscesses involving predominantly the left side of the liver, the right side was also involved. These were excluded from further comparison of left and right liver abscesses. Of the remainder, 16 (62%) left-sided and 77 (83%) right-sided abscesses were solitary. Clinical features were similar in both groups but epigastric mass was more frequent in left-sided lesions. After an initially conservative management policy, surgical drainage was necessary in 87.5% of solitary left-sided liver abscesses as opposed to 64% of solitary right-sided abscesses. No intrapericardial ruptures were noted, but 2 pericardial effusions required drainage. There was no mortality but 3 patients with solitary left-sided abscesses ruptured. The important role of ultrasound in the diagnosis and follow-up period is stressed. Patients with solitary left-sided abscesses are identified as being at risk. Abscess drainage is recommended in this group.
Insights
Left-sided liver abscesses in children are less common but carry a higher risk of complications. Surgical drainage is recommended for solitary left-sided abscesses due to increased rupture risk.
Area of Science:
- Pediatric Surgery
- Hepatology
- Infectious Diseases
Background:
- Liver abscesses are serious infections requiring prompt diagnosis and management.
- Left-sided liver abscesses are less frequent but associated with more complications than right-sided ones.
Purpose of the Study:
- To compare the clinical features, causative organisms, and management outcomes of left-sided versus right-sided liver abscesses in children.
- To identify risk factors and recommend optimal treatment strategies for pediatric liver abscesses.
Main Methods:
- Retrospective review of 124 pediatric liver abscess cases from 1974-1990.
- Analysis of clinical data, microbial cultures, imaging findings (ultrasound), and treatment outcomes.
- Comparison of left-sided (n=26) and right-sided (n=98) abscesses, excluding cases with multiple lobes involved.
Main Results:
- Left-sided abscesses were less common (26 vs. 98) and more frequently solitary (62% vs. 83%).
- Epigastric mass was more frequent in left-sided lesions; otherwise, clinical features were similar.
- Surgical drainage was required in 87.5% of solitary left-sided abscesses versus 64% of solitary right-sided abscesses.
- Three patients with solitary left-sided abscesses experienced rupture; no mortality was observed.
Conclusions:
- Solitary left-sided liver abscesses in children represent a high-risk group requiring prompt surgical intervention.
- Ultrasound plays a crucial role in diagnosis and follow-up.
- Early abscess drainage is recommended for solitary left-sided liver abscesses to prevent complications.