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COMMENTARY
Year : 2019  |  Volume : 12  |  Issue : 4  |  Page : 365-366  

Unusual complications of liver abscess in children


Department of Pediatric Surgery, Gandhi Medical College and Associated Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India

Date of Web Publication8-Jul-2019

Correspondence Address:
Rajendra Kumar Ghritlaharey
Department of Pediatric Surgery, Gandhi Medical College and Associated Kamla Nehru and Hamidia Hospitals, Bhopal - 462 001, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_178_18

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How to cite this article:
Ghritlaharey RK. Unusual complications of liver abscess in children. Med J DY Patil Vidyapeeth 2019;12:365-6

How to cite this URL:
Ghritlaharey RK. Unusual complications of liver abscess in children. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 Oct 21];12:365-6. Available from: http://www.mjdrdypv.org/text.asp?2019/12/4/365/262231



Liver abscess occurs across all the age groups.[1],[2] The incidence of liver abscess has significantly declined in developed countries; however, still, the incidence is high in developing countries.[1],[2],[3] Liver abscess occurring in pediatric population are relatively uncommon in developed countries; however, the incidence is still considerably high in developing countries.[1] Most commonly, liver abscess is pyogenic in nature, followed by amebic liver abscess.[1],[2],[3] The most of the liver abscess in children involved the right lobe of liver, and are mostly solitary liver abscess.[4] Complications are known with untreated liver abscess and common complications are sepsis, empyema/pleural collection, and rupture of liver abscess into the peritoneal or pleural cavity.[5]

Rare and unusual complications can also occur in children due to liver abscess and are; gastrointestinal fistula formation, brocho-biliary fistula, inferior vena caval and right atrial thrombosis,  Budd-Chiari syndrome More Details, and dysphagia. These complications occurred either due to the mass/pressure effect of liver abscess at the adjacent organs or due to the rupture of liver abscess.[6],[7],[8],[9],[10]

In general, the ultrasonography (USG) examination is a best radiological tool not only for the initial evaluation of developing liver abscess but also used for the diagnosis of liver abscess. USG is also utilized for the evaluation of the response of the therapy offered and also used during follow-up period for the evaluation of liver.[1],[4],[5],[11] Computed tomography (CT) scan of the abdomen is also frequently utilized as a diagnostic modality, and less frequently, magnetic resonance imaging has also been advice for the diagnosis and differential diagnosis of liver abscesses. The sensitivities of USG and CT scans for the detection of liver abscess ranged for 85% to 97%.[11]

Management of pediatric liver abscess is based on the nature of abscess (pyogenic or amoebic), size and location of lesion, and with or without complication. In general, small liver abscess or developing liver abscesses are best managed with medical therapy, and consists of anti-bacterial and or anti-amebicidal therapy along with other supportive therapy as and when required.[1],[4],[5],[10]

Liver abscess not responding to medical management, large size liver abscess, liver abscess involving liver surface, or liver abscess impending rupture, and above all require invasive procedures for their management. Percutaneous USG-guided needle aspiration is simplest and best way of therapy for many of the liver abscesses. USG-guided percutaneous insertion of catheter within the liver abscess cavity is also an option in selected cases. Few of the cases of liver abscess may require open drainage or formal laparotomy for its drainage.[1],[5] Pleural effusion/empyema is a common complication of liver abscess and developed either due to trans diaphragmatic migration or rupture of liver abscess into the pleural cavity and require additional therapy in the form of needle aspiration or intercostal chest tube drainage.[5],[10] Cases of liver abscess with rare and unusual complications require high clinical suspicion, may require additional diagnostic modalities for its confirmation and also require additional surgical therapy for its management.[6],[7],[8],[9] Prompt diagnosis and utilization of the optimal therapy have resulted in a significant decline in the mortality relating to the pediatric liver abscess, but it occurs.[1],[5]

In summary; incidence of pediatric liver abscess is still high in developing countries. Pyogenic liver abscess is the most common type of liver abscess. USG of the abdomen is the best radiological modality not only for the diagnosis of liver abscess and observation of the therapy offered, but also utilized during follow-up period. Therapeutic options for the management of liver abscess are; medical management alone, or medical management along with USG-guided needle aspiration/catheter drainage, and some cases also require open drainage. Rare and unusual complications of liver abscess can also occur in children, and require high index of suspicion for the diagnosis, and also require additional therapy for the management.



 
  References Top

1.
Mishra K, Basu S, Roychoudhury S, Kumar P. Liver abscess in children: An overview. World J Pediatr 2010;6:210-6.  Back to cited text no. 1
    
2.
Poovorawan K, Pan-Ngum W, Soonthornworasiri N, Kulrat C, Kittitrakul C, Wilairatana P, et al. Burden of liver abscess and survival risk score in Thailand: A Population-based study. Am J Trop Med Hyg 2016;95:683-8.  Back to cited text no. 2
    
3.
Congly SE, Shaheen AA, Meddings L, Kaplan GG, Myers RP. Amoebic liver abscess in USA: A population-based study of incidence, temporal trends and mortality. Liver Int 2011;31:1191-8.  Back to cited text no. 3
    
4.
Srivastava A, Yachha SK, Arora V, Poddar U, Lal R, Baijal SS. Identification of high-risk group and therapeutic options in children with liver abscess. Eur J Pediatr 2012;171:33-41.  Back to cited text no. 4
    
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Roy Choudhury S, Khan NA, Saxena R, Yadav PS, Patel JN, Chadha R, et al. Protocol-based management of 154 cases of pediatric liver abscess. Pediatr Surg Int 2017;33:165-72.  Back to cited text no. 5
    
6.
Srikanth KP, Thapa BR, Lal SB. Gastrointestinal fistulization in amebic liver abscess. Indian Pediatr 2016;53:253-5.  Back to cited text no. 6
    
7.
Kumar P, Mehta P, Ismail J, Agarwala S, Jana M, Lodha R, et al. Brocho-biliary fistula: A rare complication after ruptured liver abscess in a 3½ year old child. Lung India 2015;32:489-91.  Back to cited text no. 7
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8.
Bagri N, Yadav D, Hemal A. Inferior vena caval and right atrial thrombosis: Complicating pyogenic liver abscess. Indian Pediatr 2013;50:701-3.  Back to cited text no. 8
    
9.
Mehrotra G, Singh RP, Krishna A, Singh BK. Pyogenic liver abscess causing acute Budd-Chiari syndrome. Ann Trop Paediatr 1992;12:451-3.  Back to cited text no. 9
    
10.
Dysphagia: An unusual complication of caudate lobe liver abscess. Med J DY Patil Vidyapeeth 2019;12. [In press].  Back to cited text no. 10
    
11.
Bächler P, Baladron MJ, Menias C, Beddings I, Loch R, Zalaquett E, et al. Multimodality imaging of liver infections: Differential diagnosis and potential pitfalls. Radiographics 2016;36:1001-23.  Back to cited text no. 11
    




 

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