An alternative approach to pyogenic hepatic abscess in childhood

Childhood pyogenic hepatic abscess is rare and remains a difficult diagnostic problem. Seven cases in six children were treated over a 13 year period. There was a recurrence in one patient 7 years after the first presentation. Four patients had identified predisposing factors, namely, chronic granulomatous disease, acute appendicitis, previous abdominal surgery and umbilical vein catheterization, while the other two were cryptogenic. There were no specific symptoms and signs but the combination of unexplained pyrexia, upper abdominal tenderness, hepatomegaly and leucocytosis should raise the suspicion of hepatic abscess. Four cases were diagnosed by ultrasound, one by radionuclide scan and the other two at laparotomy. Treatment in the earlier years was by transabdominal drainage. In the later part of the series, percutaneous catheter drainage using ultrasound guidance was achieved with satisfactory result. Ultrasonography can provide an early diagnosis and effective treatment can be achieved with percutaneous catheter drainage in combination with appropriate antibiotic therapy.     

Percutaneous transhepatic alcoholization: a new therapeutic strategy in children with chronic granulomatous disease and liver abscess

Children affected with chronic granulomatous disease develop severe infections, which frequently evolve to abscess. In most instances the liver is involved. We report a case of liver abscess successfully treated by percutaneous transhepatic alcoholization after antibiotic therapy and percutaneous drainage had failed. This procedure avoided the need for hepatic resection, which is associated with high morbidity in such patients.     

Diagnostic et traitement des abcès primitifs du psoas chez l'enfant

PurposeTo evaluate the value of ultrasound and computed tomography in the diagnosis and treatment of primitive psoas abscess in children.Patients and methodsWe retrospectively studied 20 cases of primitive psoas abscess seen between 1987 and 2005. All children were investigated by abdominal ultrasound and computed tomography. Percutaneous drainage of the abscess was performed in 15 cases.ResultsThe mean age of the children was 7.8 years (range: 11 months-12 years). Fever and pain were the presenting symptoms. Ultrasonography established the diagnosis in all patients. CT confirmed the diagnosis and allowed a percutaneous needle aspiration in all cases. Staphylococcus auerus was isolated in 19 patients and streptococcus in 1 patient. The catheter drainage was successful in 14 cases. A surgical drainage was necessary for four children. The two other patients were treated with only antibiotic.ConclusionUS and CT are useful for accurate diagnosis of primitive psoas abscess in children. CT-guided percutaneous drainage is a safe and effective alternative to surgery in the management of primitive psoas abscess.     

Percutaneous drainage of subperiosteal abscess: a potential treatment for osteomyelitis

Objective

Intravenous antibiotics and surgical drainage are the accepted methods of treating osteomyelitis complicated by abscess formation. The objective of this study was to determine whether percutaneous drainage of subperiosteal abscess is a potential treatment for osteomyelitis.

Materials and methods

Three pediatric patients with subperiosteal abscesses from acute osteomyelitis had percutaneous drainage with sonographic and fluoroscopic guidance using a Seldinger technique and an 8-F catheter.

Results

Two patients required no further intervention and had thee drainage catheter removed after 72 h. After completing a course of antibiotics they healed completely. One patient, after a week of purulent drainage, required open drainage including a bone .debridement of an area of septic necrosis.

Conclusion

Percutaneous drainage of subperiosteal abscess may be an alternative to surgical drainage when medical therapy alone is inadequate. Development of intraosseous abscess, necrosis or persistent drainage suggests further intervention may be necessary.     

Chronic granulomatous disease: value of the newer imaging modalities

The contribution of computed tomography (CT), ultrasound (US), and nuclear medicine studies in the evaluation and management of seven patients with chronic granulomatous disease was retrospectively reviewed. These modalities proved valuable in detecting sites of infection, particularly in the abdomen. Three patients had liver abscesses, two had suppurative retroperitoneal lymphadenopathy, one had empyema, and one had a scrotal abscess. Furthermore, CT or US-guided percutaneous aspiration and/or drainage of infected material was successfully performed on three separate occasions in a single patient, obviating the need for surgery. The newer imaging modalities are useful in the prompt diagnosis and in some instances non-operative therapy of complications of chronic granulomatous disease.     

A case of an iliopsoas abscess in a neonate

The present study describes a male neonate with an iliopsoas abscess. He was born by Caesarean section at 35 weeks and 3 days gestation. At 24-days-old he had a fever and localized swelling of the groin to the femur. By ultrasonography (US) and computed tomography (CT), the swelling was diagnosed as iliopsoas abscess. We treated him through percutaneous needle drainage and antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in the culture of the fluid from the abscess and the urine. US and CT were useful for the diagnosis and provided guidance for the needle puncture and follow-up of the iliopsoas abscess.     

Hepatic abscess in sickle cell anaemia: a rare manifestation

A child with sickle cell anaemia developed a hepatic abscess, which was managed successfully by percutaneous drainage under ultrasound control. A history of attacks of pain dissimilar to usual vaso-occlusive crises should be treated with suspicion and investigated appropriately.     

Hepatic abscess in sickle cell anaemia: a rare manifestation.

A child with sickle cell anaemia developed a hepatic abscess, which was managed successfully by percutaneous drainage under ultrasound control. A history of attacks of pain dissimilar to usual vaso-occlusive crises should be treated with suspicion and investigated appropriately.     

Ultrasound-guided percutaneous catheter drainage of splenic abscess

Splenic abscess is an uncommon clinical condition which is usually treated with splenectomy with its attendant risks. Image-guided percutaneous drainage of splenic abscesses has been described in adults. The case of a 12-year-old boy with a splenic abscess who was successfully treated with ultrasound-guided percutaneous catheter drainage is presented. Image-guided percutaneous drainage in children can be a safe and effective alternative to surgery.     

Ilio-psoas abscess: diagnosis and management

The triad of fever, limp, and pain in the flank, pelvis or leg often leads to the evaluation of the hip, genitourinary or gastrointestinal system. In the past 6 years, at our hospital, five adolescents and one young adult with these symptoms have had an ilio-psoas abscess, all diagnosed by ultrasonography. Once the diagnosis was established, four patients were treated successfully by percutaneous retroperitoneal drainage guided by ultrasonography [3] or computed tomography [1]. Catheter drainage averaged 11 days accompanied by appropriate antibiotics. The remaining two patients had surgical transperitoneal drainage. Growth ofStaphylococcus aureus, from an ilio-psoas abscess indicates that the process is primary in origin. Growth of fecal flora suggests an intra-abdominal process and warrants further investigation. Ilio-psoas abscess can be readily diagnosed by ultrasonography or computed tomography and treated by percutaneous retroperitoneal drainage.     

Ilio-psoas abscess in neonates: treatment by ultrasound-guided percutaneous drainage

Ilio-psoas abscess is rare in neonates and is usually treated by surgical drainage. We report two cases of ilio-psoas abscess in 15- and 21-day-old infants successfully treated by US-guided percutaneous drainage as a supplement to antibiotic therapy. Clinical improvement was observed within 24–48 h of drainage and subsequent imaging demonstrated resolution of the abscess cavity. The analysis of these cases and of those previously reported indicates that imaging is essential for diagnosis. In neonates, US-guided percutaneous drainage may represent the first-choice treatment of this disease in association with antibiotic therapy. Received: 6 March 2000/Accepted: 24 April 2000     

Bacterial liver abscess in children

From November 1987, 136 children with bacterial liver abscess were encountered. There were 97 males and 39 females and the age ranged from 1-15 years (mean = 8.42 years). The clinical signs and symptoms of liver abscess were confirmed by radiography, ultrasonography, percutaneous transhepatic drainage (PTHD) and radioisotope scanning. 103 children had solitary abscess and the remaining 33 children, multiple abscesses. Of the children with multiple abscesses, 23 had abscesses confined to one lobe of the liver and 10 had involvement of both lobes of the liver. 86 children had culture of liver abscesses done and only 63 (73.2%) yielded positive culture. Staphylococcus aureus and Escherichia coli were the commonest organisms cultured from liver abscesses. 72 cases had drainage of liver abscesses, one of them ended up with hepatic artery ligation. A further 15 cases treated by PTHD survived. Of the remaining 49 cases who had antibiotic therapy, 2 died of septicemia, giving a mortality rate of 1.47%. 36.3% of children with liver abscesses responded to antibiotic therapy. The indication and method for surgical management are discussed. Percutaneous transhepatic drainage (PTHD) of liver abscesses, under the guidance of ultrasonography is found to be safe and effective.     

Renal and peri-renal abscesses in children: proposed physio-pathologic mechanisms and treatment algorithm

Renal and perinephric abscess in children are uncommon. Three basic pathophysiologic mechanisms are involved, namely, hematogenous spread, ascending infection and contamination by proximity to an infected area. Six pediatric patients diagnosed with renal abscess were treated at our institution from 1990-2000. Five patients were females; ages ranged from 3-17 years (mean 11.8 years). Diagnosis, as expected, was not readily apparent at presentation. Computerized tomography and renal sonograms were the most useful imaging modalities. Gram-negative bacteria were commonly isolated; only one patient grew Staphylococcus aureus. All patients received broad-spectrum intravenous antibiotics. Additional treatments consisted of percutaneous drainage (4 patients), exploratory laparotomy (1 patient, for presumed Wilm's tumor) and nephrectomy (2 patients). A new classification of the etiologic mechanisms of this condition is proposed along with a simple and practical treatment algorithm.     

Hepatic abscesses in childhood: retrospective study about 33 cases observed in New-Caledonia between 1985 and 2003]

Hepatic abscesses in childhood are rarely observed in Europe. The aim of this word was to study how to diagnose and how to treat an hepatic abscess. METHODS: Between 1985 and 2003, we recensed retrospectively 33 cases of hepatic abscesses hospitalised in the paediatric unit of Noumea. RESULTS: Children were mainly melanesians (79%), 7 years old on average, having abdominal pains, a clinical and biological infectious syndrome, and abscesses images on ultrasonography or computed tomography. The identified micro-organisms included Entamoeba histolytica in 30% (10 cases); Staphylococcus aureus in 15% (five cases), Staphylococcus coagulase negative in 6% (two cases), Streptococcus D in 3% (one case); Bartonella henselae in 9% (three cases); ascaris in 6% (two cases); Mycobacterium tuberculosis in 6% (two cases). In eight cases no bacteria was identified (24%) but the good evolution after antibiotics and the negative amoebic serology looked like pyogenic abscesses. Two abscesses were aspirated, two were drained, one child had a surgical intervention. There was no death. Following a mean duration of 1 month for antibiotics treatment, outcome was always favourable. CONCLUSION: Diagnosis of hepatic abscess can be difficult. Ultrasonography shows the abscess but not the causal agent. The amoebic serology is sensible, consequently, its negativity leads to evoke a pyogenic agent. Early antibiotic treatment against pyogenic, anaerobic bacteria, and Entamoeba histolytica is required. Hepatic abscesses in ascaridiosis, tuberculosis and cat-scratch disease are less frequently encountered. If diagnosis remains doubtful or clinical evolution worsens, or if abscess volume increases, a percutaneous aspiration or drainage is needed.     

小儿阑尾周围脓肿61例临床分析

目的总结19年来北京大学第一医院对于小儿阑尾周围脓肿的治疗经验,探讨治疗策略的变化。方法回顾性分析自1993年至2011年间,作者收治的61例阑尾周围脓肿患儿临床资料。治疗方法包括静脉输入抗生素、理疗、B超引导下脓肿穿刺及手术治疗。结果保守治疗32例,1例于4周后发生肠梗阻,1例1年后再发脓肿;B超引导下行脓肿穿刺4例,无并发症;手术25例（10例行脓肿切开引流并切除阑尾,其余行脓肿切开引流）,出现并发症（切口感染、肠梗阻、残余脓肿）11例。4例于随访期间发作急性阑尾炎,予手术切除阑尾,其中3例存在阑尾粪石。结论对于阑尾周围脓肿,应首选以静脉输入抗生素为主的保守治疗方法;对于部分脓肿较大的患儿,可在B超引导下行穿刺引流。存在阑尾粪石的患儿,应行二期阑尾切除术。     

Pyomyositis and staphylococcal scalded skin syndrome

Pyomyositis is a rare musculoskeletal infection in non-tropical countries. We report a child who had pyomyositis complicated by staphylococcal scalded skin syndrome. This complication has not previously been described in patients with pyomyositis. Early diagnosis of pyomyositis was made by ultrasound examination, and percutaneous needle drainage under ultrasound guidance was performed. Pus aspirated and blood cultures grew Staphylococcus aureus . No open surgical drainage was required and resolution of the abscess was documented by serial ultrasound examinations.     

Determinants of postoperative abscess occurrence and percutaneous drainage in children with perforated appendicitis

Purpose

Postoperative abscesses after perforated appendicitis have no clear risk factors or indications for percutaneous drainage. Our study addressed these two issues.

Methods

A logistic regression model was used to delineate risk factors for postoperative abscess in children with perforated appendicitis treated during a recent 5-year period. Drainage of abscess was compared to antibiotic treatment.

Results

Postoperative abscess occurred in 42 (14.8 %) of 284 patients. Higher WBC count, presence of bowel obstruction at presentation, diffuse peritonitis with a dominant abscess at surgery, and one specific surgeon were significantly associated with postoperative abscess, while fever or pain requiring narcotics at the time of abscess diagnosis was significantly associated with drainage. Compared to non-drainage, those drained had longer hospital stay including readmissions (15.9 ± 5.3 vs. 12.2 ± 4.6 days, p < 0.005) and less readmissions (9.5 vs. 33.3 %, p = 0.06). Over the 5-year period, there was no increased trend in abscess occurrence (p = 0.56), but there was an increased trend in the use of percutaneous drainage (p = 0.02).

Conclusions

The risk of a postoperative abscess can be predicted by specific clinical characteristics, surgical findings, and treatment-related factors. Percutaneous drainage was associated with longer hospital stays, but less readmissions.     

Psoas abscess complicated by vesical fistula in a child managed by non-surgical therapy

We report an unusual case of a 2-year-old child with a psoas abscess fistulizing to the bladder, managed by non-surgical therapy including urethral catheter drainage, percutaneous abscess drainage and intravenous antibiotics.     

Ilio-psoas abscess in the paediatric population: treatment by US-guided percutaneous drainage

Background. Image-guided percutaneous drainage has been shown to be a safe and effective alternative to surgery in the management of psoas abscess in adults and adolescents. There is little information on its use in children. Objective. To evaluate the safety and efficacy of US-guided percutaneous needle aspiration and catheter drainage of ilio-psoas abscesses. Materials and methods. A retrospective review of 14 children with 16 ilio-psoas abscesses (10 pyogenic and 4 tuberculous) who were treated by US-guided percutaneous needle aspiration (n = 5) or catheter drainage (n = 9) along with appropriate antimicrobial therapy. Results. Percutaneous treatment was successful in 10 of the 14 patients; all showed clinical improvement within 24–48 h of drainage and subsequent imaging demonstrated resolution of the abscess cavities. Surgery was avoided in all of these ten patients except one, who underwent open surgical drainage of ipsilateral hip joint pus. Of the other four patients, two had to undergo surgical drainage of the ilio-psoas abscesses after failure of percutaneous treatment, one improved with antibiotics after needle aspiration failed to yield any pus, and one died of continuing staphylococcal septicaemia within 24 h of the procedure. There were no procedural complications. Conclusions. Percutaneous drainage represents an effective alternative to surgical drainage as a supplement to medical therapy in the management of children with ilio-psoas abscesses. Received: 12 June 1997 Accepted: 9 January 1998     

Surgery and granulocyte transfusions for life-threatening infections in chronic granulomatous disease

We report two patients with chronic granulomatous disease (CGD) and life-threatening infections: a 10 10/12-year-old boy had Aspergillus fumigatus spondylitis with destruction of the 11th vertebral body and paravertebral abscess formation, and an 8 5/12-year-old boy had multiple Staphylococcus aureus hepatic abscesses with subphrenic abscess formation. Both patients failed to respond to intense antimicrobial therapy but showed a remarkable recovery following surgical drainage combined with granulocyte transfusions. These results suggest that antimicrobial therapy and surgical drainage followed by granulocyte transfusions may be the ideal mode of treatment for severe infections in patients with CGD.