Study of liver abscess in pediatrics patients in tertiary health care institute

Abstract

liver abscess is mostly occurring due to the infection of bacteria, parasite like amoeba. The incidence of amoebic liver abscess varies all over the world and most of cases found in developing countries remain unreported. study of liver abscess in pediatric patients in tertiary health care institute. This was a prospective study, carried out in 64 at our tertiary care center, J K Lon Hospital, SMS Medical College, Jaipur from May 2022 to April 2023. We collect all data related to patients like demography, clinical features, laboratory finding, and imaging records and recorded on a pre-decided proforma. There were 64 patients (36 male, 56.25% and 28 females, 43.75%), The male to female ratio was 1.25:1. The mean age of presentation was 7.5 years. The common presenting symptom was anorexia in 55 (85.93%) cases. Most common symptom was abdominal pain in 60 (93.75%) cases, fever 58 (90.625%), and vomiting in 40 (62.5%%) cases. Diarrhoea was present in 5 patients. Anemia was most common clinical sign in present in 40 (62.5%) patients, weight loss 38 (59.37%). Respiratory distress was present in 4 (6.25%) due to pleural effusion and peritonitis cases. Jaundice was present in 5 (7.81%) . 5 case [7.81%] of patients had raised bilirubin and 28 patients [43.75%] had raised alkaline phosphatase levels. Raised SGOT and SGPT was 43.75 %. 34 patients of Amoebic liver abscess and 30 of Pyogenic liver abscess. 53.12% (34 cases) patients had amoebic liver abscess in the right lobe. less than 50 cc size of abscess was present in 24 patients (37.5%) cases. Most of the patients have cavity size 50-150cc. more than 200cc cavity found only in 10 cases. Average cavity size is 166cc. peritoneal ruptured liver abscess in 2 cases [3.12%%] had features of peritonitis, pleural effusion in 2 cases with complain of respiratory difficulties. Conservative medical management was done in 2 patients, USG guided needle aspiration 20 patients and 40 patients underwent pigtail catheter insertion. 12 fr pigtail catheter insertion was done in 30 patients and 10 patients underwent double pigtail catheter insertion. Exploration and drainage of liver abscess was done in 2 patients. In present study, mean hospital stay was 10.28 days. Hospital stays ranges from 5 to 17 days. Most of the patients stays 5 to 10 days [56.25%]. all amoebic liver abscesses were sterile. Most commonly found organism on pus culture was Staphylococcus in 25% cases followed by E. coli in 21.87% cases in pyogenic liver abscesses. from this study we found that ultrasonography is the standard modality for diagnostic and therapeutic management as well as for drainage and follow up. We also found that USG guided pigtail catheter drainage is a superior therapeutic approach than needle aspiration for large liver abscess, and abscess cavity resolves better in case of pigtail catheter drainage. We also concluded that ruptured liver abscess can also be managed with two pig tail catheter insertion.