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Identification of high-risk group and therapeutic options in children with liver abscess

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Abstract

The outcome of children with liver abscess (LA) depends upon prompt diagnosis and intervention. We evaluated the etiology, clinical profile, various interventional modalities of management and outcome of children with LA. A total of 39 hospitalized children (mean age 7.2 ± 3.9 years) with radiologically proven LA were analyzed. Parenteral antibiotics, percutaneous drainage (PD) or open surgical drainage (OSD) was done as required. Cases with ruptured or impending rupture of LA, upper gastrointestinal bleed, jaundice, pleural effusion or consolidation were labeled as “high risk” cases. Triad of fever, pain and hepatomegaly was the most common presentation. Single abscess was present in 66.7% and right lobe was involved in 69.2% of cases. Majority of LA were pyogenic (PLA, 25/39). Amebic liver abscess (ALA) and PLA had similar clinical and laboratory profile except that multiloculated abscess on ultrasonography was a feature of PLA (12/25 vs. 0/11; p = 0.006). Cases with ALA settled significantly more often with antibiotics alone (5/11 vs. 3/25; p = 0.04) than PLA and none required surgery (0/11 vs. 7/25; p = 0.03). Subjects with “high-risk” LA (n − 26) had significantly larger abscesses, more polymorphonuclear leucocytosis (74 ± 15% vs. 61 ± 13%; p = 0.01) in peripheral blood and need of drainage (24/26 vs. 7/13; p = 0.03) than patients with average-risk LA. Based on the results, 38/39 children recovered, with complete abscess resolution in 28, over 48 ± 63.8 days. In conclusion, ALA, although similar in presentation, are uniloculated, and patients with ALA recover more often without drainage than patients with PLA. Patients with “high risk” LA are more common and have a good outcome with drainage. PD, being safe, efficacious and less invasive than OSD, should be the preferred drainage procedure.

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Abbreviations

LA:

Liver abscess

ALA:

Amoebic liver abscess

PLA:

Pyogenic liver abscess

PD:

Percutaneous drainage

PNA:

Percutaneous needle aspiration

PCD:

Percutaneous catheter drainage

OSD:

Open surgical drainage

USG:

Ultrasonography

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Acknowledgements

The authors declare that they do not have any conflict of interest including financial concerns. This study was not sponsored by any organization.

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, Uttar Pradesh, India

    Anshu Srivastava, Surender Kumar Yachha, Vikas Arora & Ujjal Poddar

  2. Department of Pediatric Surgical Superspeciality, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, Uttar Pradesh, India

    Richa Lal

  3. Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, Uttar Pradesh, India

    Sanjay S. Baijal

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  1. Anshu Srivastava
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  2. Surender Kumar Yachha
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  3. Vikas Arora
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  4. Ujjal Poddar
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  5. Richa Lal
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  6. Sanjay S. Baijal
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Correspondence to Surender Kumar Yachha.

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Srivastava, A., Yachha, S.K., Arora, V. et al. Identification of high-risk group and therapeutic options in children with liver abscess. Eur J Pediatr 171, 33–41 (2012). https://doi.org/10.1007/s00431-011-1481-y

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  • DOI: https://doi.org/10.1007/s00431-011-1481-y

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