Liver Abscesses, Pylephlebitis, and Appendicitis in an Adolescent Male

  • Anup J. PatelEmail author
  • Phat V. Ong
  • John P. Higgins
  • John A. Kerner
Stanford Multidisciplinary Seminars

Case Presentation and Evolution

A 14-year-old Tongan male presented with a two-day history of tactile fevers and night sweats. He had a three-day history of dull right upper quadrant (RUQ) abdominal pain that extended to his upper back. The pain was intermittent in nature, characterized as five on a ten-point scale, occurred at least three times per day, was worse when laying on the right side, and slightly worse with eating, but not restrictive of dietary intake. The patient had no nausea or emesis or other symptoms. He had not consumed any uncooked or undercooked foods, nor had recent travel or camping. He had no prior hospitalizations, chronic medical problems or surgeries. His physical exam was only remarkable for localized and exquisite tenderness to palpation of his RUQ with no flank tenderness. The liver span was difficult to assess due to his pain, and he had no splenomegaly. There was no rebound or guarding.

Laboratory tests revealed a white blood cell count of 10.2/mm3,...


Appendicitis Liver Abscess Laparoscopic Appendectomy Echinococcus Amebiasis 
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  1. 1.
    Chang TN, Tang L, Keller K, Harrison MR, Farmer D, Albanese CT. Pylephlebitis, portal-mesenteric thrombosis, and multiple liver abscesses owing to perforated appendicitis. J Pediatr Surg. 2001;36:E19–E21.CrossRefPubMedGoogle Scholar
  2. 2.
    Branum GD, Tyson GS, Branum MA, Meyers WC. Hepatic abscess. Changes in etiology, diagnosis, and management. Ann Surg. 1990;212:655–662.CrossRefPubMedGoogle Scholar
  3. 3.
    Miedema BW, Dineen P. The diagnosis and treatment of pyogenic liver abscesses. Ann Surg. 1984;200:328–335.CrossRefPubMedGoogle Scholar
  4. 4.
    Liu KW, Fitzgerald RJ, Blake NS. An alternative approach to pyogenic hepatic abscess in childhood. J Paediatr Child Health. 1990;26:92–94.CrossRefPubMedGoogle Scholar
  5. 5.
    Slovis TL, Haller JO, Cohen HL, Berdon WE, Watts FB. Complicated appendiceal inflammatory disease in children: Pylephlebitis and liver abscess. Radiology. 1989;171:823–825.PubMedGoogle Scholar
  6. 6.
    Muorah M, Hinds R, Verma A, et al. Liver abscesses in children: A single center experience in the developed world. J Pediatr Gastroenterol Nutr. 2006;42:201–206.CrossRefPubMedGoogle Scholar
  7. 7.
    Belkahla N, Maamouri N, Ouerghi H, et al. Phlegmonous appendicitis revealed by pyogenic abscesses. Tunis Med. 2007;85:569–579.Google Scholar
  8. 8.
    Usdan LS, Massinople C. Multiple pyogenic liver abscesses associated with occult appendicitis and possible Crohn’s disease. Tenn Med. 2002;95:463–464.PubMedGoogle Scholar
  9. 9.
    Sorenson MR, Baekgaard N, Kirkegaard P. Pyogenic liver abscess. A case report with a short review of current concepts of diagnosis and management. Acta Chir Scand. 1983;149:437–439.Google Scholar
  10. 10.
    Mahieu X, Boverie J, Lemaire JM, Jacquet N. Pyogenic liver abscess. Diagnostic and therapeutic approach: A case report. Acta Chir Belg. 1993;93:220–223.PubMedGoogle Scholar
  11. 11.
    Chung RT, Friedman LS. Bacterial, parasitic, and fungal infections of the liver, including liver abscess. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, PA: Saunders Elsevier; 2006:1731–1753.Google Scholar
  12. 12.
    Marova K, Chochola M, Golan L, Krivanek J, Aschermann M. Liver abscesses with portal and mesenteric vein thrombosis in combination with late onset of appendicitis. Cas Lek Cesk. 2005;144:489–493.PubMedGoogle Scholar
  13. 13.
    Nishimori H, Ezoe E, Ura H, et al. Septic thrombophlebitis of the portal and superior mesenteric veins as a complication of appendicitis: Report of a case. Surg Today. 2004;34:173–176.CrossRefPubMedGoogle Scholar
  14. 14.
    Lim HE, Cheong HJ, Woo HJ, et al. Pylephlebitis associated with appendicitis. Korean J Intern Med. 1999;14:73–76.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Anup J. Patel
    • 1
    Email author
  • Phat V. Ong
    • 2
  • John P. Higgins
    • 3
  • John A. Kerner
    • 1
  1. 1.Division of Gastroenterology, Hepatology, and Nutrition, Department of PediatricsLucile Packard Children’s HospitalPalo AltoUSA
  2. 2.Department of RadiologyStanford University Medical CenterStanfordUSA
  3. 3.Department of Pathology and Laboratory MedicineStanford University Medical CenterStanfordUSA

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