Related Experiment Videos
Amebic hepatic abscess in children
G Porras-Ramírez1, M H Hernández-Herrera, J D Porras-Hernández
1Unidad de Cirugía, Unidad Hospitalaria La Paz, Puebla, Mexico.
Insights
Medical treatment is effective for small amebic hepatic abscesses in children. Percutaneous needle aspiration successfully managed impending complications, while surgery was reserved for ruptured cases.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Medical Parasitology
Background:
- Amebic hepatic abscess (AHA) is a serious infection caused by Entamoeba histolytica.
- Prompt diagnosis and appropriate management are crucial for favorable outcomes in pediatric patients.
- Treatment strategies for AHA have evolved, necessitating an understanding of their efficacy in different clinical scenarios.
Purpose of the Study:
- To evaluate the treatment outcomes of pediatric amebic hepatic abscesses.
- To determine the effectiveness of medical management, percutaneous needle aspiration, and surgical intervention.
- To identify factors predicting the need for invasive procedures.
Main Methods:
- Retrospective review of pediatric patients diagnosed with amebic hepatic abscess between 1975 and 1993.
- Analysis of treatment modalities including medical therapy (dehydroemetine and metronidazole), percutaneous needle aspiration, and surgery.
- Assessment of clinical presentation, abscess characteristics, and patient outcomes.
Main Results:
- A total of 32 children (20 boys, 12 girls) were treated for AHA.
- Medical treatment alone was effective for uncomplicated, small abscesses (17 patients).
- Percutaneous needle aspiration was successful in 9 patients with impending complications, evidenced by clinical worsening, large abscess size (>6 cm) in septic patients, or signs of impending rupture.
- Fifteen patients (47%) experienced abscess rupture, requiring surgical intervention, with one mortality due to sepsis.
Conclusions:
- Medical management with dehydroemetine and metronidazole is highly effective for small, uncomplicated amebic hepatic abscesses in children.
- Percutaneous needle aspiration is a safe and effective intervention for pediatric AHA with signs of impending rupture or complications.
- Surgical intervention should be reserved for cases of ruptured amebic hepatic abscesses to minimize morbidity and mortality.
Abstract:
The authors retrospectively reviewed all case histories of children with amebic hepatic abscess treated from 1975 to 1993 at their hospital. Twenty boys and 12 girls were diagnosed. Their ages ranged from 10 months to 12 years, with a mode of 1 and 2 years. In 17 (53%) of the patients, the abscess remained confined to the liver and was treated medically with dehydroemetine and metronidazole. Imminence of complication was present in 9 patients (52%), and required percutaneous needle aspiration. Imminence of complication was evidenced by: (1) clinical worsening of the patient despite adequate medical treatment, (2) presence of an abscess of 6 cm or more in a septic patient, or (3) clinical or ultrasonographic findings of an abscess on the verge of rupture. All 9 patients did satisfactorily. Fifteen cases (47%) were complicated by rupture and required surgical treatment. One of these patients died of sepsis. Medical treatment alone was excellent for small abscesses. Percutaneous needle aspiration was a successful approach in patients with imminence of complication. Surgery was reserved for ruptured abscesses.