LIVER ABSCESS IN CHILDREN WITH CLINICAL PROFILE AND OUTCOME

Abstract

Introduction: Liver abscess (LA) in a disease in which there is involvement of involves collection of purulent material in liver parenchyma due to bacterial, parasitic, fungal or mixed infections. This is common in India and also it is 2nd highest incidence because of poor sanitation, overcrowding and inadequate nutrition. Nowadays liver abscess is growing rapidly in developing modern medicine, with the advent of many investigative procedures in diagnosis of abdominal diseases. Infection of intra abdominal abscesses and abdominal infections are main attention of the physician and to be the liver as the liver is the organ most important for the development of abscess as it is 48% of all the visceral abscesses. Liver abscess has a significant mortality rate in both developing and developed countries. It may cause complication of various intraabdominal infections; by hematogenous spread via portal vein from the gastrointestinal tract; or, may develop after traumatic injury to the liver. Common types of liver abscess are pyogenic and amoebic. In India cases of liver abscesses in children constitute more than 79 per 100,000 pediatric admissions below 12 years old. For unknown reasons male children are similar to the male adults and are affected by liver abscesses more than female children.
 Aim: The main aim of this study is to evaluate the clinical profile and outcome of liver abscess (LA).
 Material and methods: Total 30 patients with various age groups from 1years to 14 years of age group attending to Pediatrics department of this college were included for study. All the patients were evaluated for their complaints, possible predisposing factors, mode of diagnosis, interventions where there or not during their stay. Laboratory investigation like Microbiological analysis of the pus was done and on the basis of culture reports, changes in drug prescription as antibiotic treatment included ceftriaxone, amikacin and metronidazole in specific doses. According to the ultrasonography abdomen and the number and amount of abscess cavities intervention were done. Pre intervention liver functions like prothrombin concentration (PC), prothrombin time (PT) and international normalized ratio (INR) were also recorded.
 Results: During the period of study total 30 patients were included in this study. The mean age of patients was 6.2 years and age range was 3 -12 years. Male to female ratio was 1.5:1 patients shows the clinical features as fever, abdominal pain and abdominal distension. Maximum patients showed main complain as fever by 25 patients (83.3%) followed by abdominal pain (right hypochondrium) by 20 patients (66.7%) , abdominal distension by 5 patients(16.7%), Peritonnitis by 3 patients (10%) and Subacute intestinal obstruction by 2 patients (6.7%).
 Conclusion: In children liver abscess is an important cause for morbidity. Liver abscess should be suspected presenting with prolonged fever and pain in upper abdomen to the emergency department. For the diagnosis of liver abscess Ultrasonography is an easy, widely available non-invasive and cost effective investigation. If timely it is not cure it may lead to rupture and mortality. High index of suspicion, early screening and appropriate intervention in form customized management may raise good results.
 Keywords: Children, Liver abscess, Pyogenic liver abscess, Treatment