Pediatric Liver Abscess: Outcomes of Protocol-based Management and Predictors of Poor Outcome.

BACKGROUND: Liver abscess (LA) is an important cause of morbidity in children, especially in tropical countries. There is a paucity of data in pediatric LA with no standard guidelines regarding the best modality of treatment and drainage. With a large influx of patients at our center and protocol-based management; we aimed to study clinic-radiologic profile, risk factors, complications and outcomes of children with liver abscess and assessed possible predictors for poor outcomes. MATERIALS AND METHODS: This retrospective observational study was conducted from January 2019 to September 2019 at a tertiary care hospital in India. Records of all children (<12 years of age) with ultrasonographically diagnosed liver abscess were accessed for clinic-radiological and demographic profile, laboratory investigations, treatment, complications and outcomes. Patients were categorized into favorable or unfavorable groups based on predefined criteria and were compared for possible predictors of poor outcomes. Outcomes for the protocol-based management were analyzed. RESULTS: There were 120 cases of pediatric liver abscess with a median age of 5 years at presentation. The commonest clinical features were fever (100%) and pain in the abdomen (89.16%). The majority of liver abscesses were solitary (78.4%) and in the right lobe (73.3%). Malnutrition was present in 27.5%, overcrowding for 76.5% of patients and worm infestation in 2.5% of patients. Age-related leukocytosis ( P = 0.004), neutrophilia ( P = 0.013), elevated Aspartate transaminase ( P = 0.008), elevated alanine transaminase ( P = 0.007) and hypoalbuminemia ( P = 0.014) were significantly more in the unfavorable group. Overall, 29.2% of patients underwent conservative management with antibiotics alone, 25.0% underwent percutaneous needle aspiration (PNA), 49.1% underwent ultrasound-guided percutaneous drain (PCD) insertion and open surgical drainage (OSD) was needed in a single patient. The success rate was 100% for conservative management, 76.6% for PNA, 94.7% for PCD and 100% for OSD with an overall mortality of 2.5%. CONCLUSIONS: Age-related leukocytosis, neutrophilia, elevated aspartate transaminase or alanine transaminase and hypoalbuminemia at presentation are predictors of poor outcomes in pediatric liver abscess. Protocol-based management leads to the appropriate use of PNA and PCD while decreasing mortality and morbidity related to either.

Liver abscess in early infancy with no underlying risk factors: a case series.

Liver abscess in early infancy is uncommon, needs a high index of suspicion for diagnosis and carries a high mortality. It presents most frequently by a fulminant course, generalised sepsis and multiple metastatic abscesses. An underlying predisposing factor is usually attributed in nearly all cases reported to date. These include prematurity, low birth weight, umbilical catheterisation (UC), administration of hypertonic dextrose or total parenteral nutrition via UC, exchange transfusion, blood culture proven sepsis, necrotising enterocolitis, antecedent abdominal surgery, birth asphyxia, omphalitis and underlying immunodeficiency. We present three cases of early infantile liver abscesses without any identifiable predisposing factor despite extensive work-up to search for such. Early recognition and management led to a favourable outcome in all our patients.