Percutaneous aspiration versus open drainage of liver abscess in children

Abstract

Liver abscess, though a very grave problem, is rarely seen in infancy and childhood. Affected children are usually immunocompromised and are of poor socioeconomic status. Although liver abscess due to wandering ascarids is rare outside, it is common complication among children of Kashmir. Usual site of abscess is the right lobe of the liver and USG and CT of the abdomen are the main tools of diagnosis. The study was conducted over a period of 10 years from January 1991 to December 2000 and total of 129 cases were studied in the age group of 0-14 years. Diagnosis was made by a detailed clinical examination together with USG and CT of the abdomen. Out of 129 cases, 49 were treated with antibiotics alone, 55 cases were taken for open drainage, and 27 cases were taken for percutaneous aspiration under USG guidance. Percutaneous aspiration failed in five patients who were later taken for open drainage. Open method was found still to be the best modality of management, although percutaneous aspiration is safe and effective but needs lot of expertise.

Clinical, laboratory and management profile in patients of liver abscess in central India

“…They concluded that open surgical drainage is the best modality of management for liver abscess. 5 We conclude with the message that although percutaneous drainage is safe and effective the open surgical and laparoscopic procedure are most reliable and effective means of management because we can deal not only with liver abscess, but also with associated intra-abdominal pathology.…”

“…Although of considerable benefit, percutaneous drainage is not necessarily the best treatment for all patients and is associated with a significantly higher failure rate than surgical drainage. 5,[16][17][18] This is also evident from our series where 97 patients (60.63%) had USG guided aspiration and 31 patients (19.38%) had pigtail catheter drainage and were subjected to this mode of treatment, In Malik AA et al case study open surgical drainage was done in 127 cases, percutaneous drainage 26 cases and 16 cases were managed on iv antibiotics only with mortality in 19 patients, In Heneghan et al initially all patients were started with antibiotic therapy followed by USG guided percutaneous drainage in all patients out of which and only 2 patients required surgical intervention with no mortality. 3,4 Patients among them subsequently needed open surgical drainage because of inadequate response to percutaneous drainage.…”

“…On the other hand liver abscess on CT appears as a low density lobulated lesion with poorly defined edges. 5 Hepatic scans utilizing radioisotopes are obsolete for definition of hepatic abscess while magnetic resonance imaging does not provide information of greater usefulness than ultrasound or CT scanning. Surgical treatment continues to give the best chance of survival in patients with Liver abscess.…”

Pyogenic liver abscess mimicking pleural effusion

“…Polymicrobial aetiology is common, and blood culture may be negative in about half of cases. 7,11 Eosinophilia, found in this case, may be due to previous helminthic infestation. Helminthiasis has been implicated in pyogenic liver abscess in children without pre-existing liver lesions, by inducing eosinophilia and granulomatous changes while passing through the liver.…”

“…1,2 Clinical features of liver abscesses in children include fever and right hypochondrial tenderness in about 100% of cases, hepatomegaly in 85%, and vomiting in 25%. 7 Symptoms such as cough, dyspnoea and severe chest pain suggest intrathoracic involvement due to sympathetic pleural effusion or pneumonia. Rarely, pyogenic liver abscess may present with thoracic empyema or pericardiac tamponade, due to rupture of an abscess in the left lobe of the liver.…”