Inferior vena caval and right atrial thrombosis: Complicating pyogenic liver abscess

Vascular complication of liver abscess are rare but life-threatening. We herein report a 2 year 9 month boy with pyogenic hepatic abscess complicated by inferior vena cava thrombus extending to right atrium. Early clinical suspicion aided by ultrasonography and echocardiography confirmed the diagnosis. The child was treated successfully with timely medical and surgical intervention.     

Solitary liver abscess in a healthy child presenting with fever of unknown origin.

Pyogenic liver abscess is rarely encountered in normal children. We report a case of solitary pyogenic liver abscess in a healthy child aged 8 months. He presented with fever of unknown origin and mild hepatomegaly. Full recovery was achieved by surgical intervention and prolonged antibiotic treatment. Management and recommended treatment in children with liver abscess are presented.     

Pyogenic liver abscess and peritonitis due to Rhizopus oryzae in a child with Papillon�CLefevre syndrome

Papillon-Lefevre syndrome (PLS) is an autosomal recessive disease that is characterized by symmetric palmoplantar keratodermatitis and severe periodontal destruction. Mutations in the cathepsin C gene (CTSC) have recently been detected in PLS. Immune dysregulation, due to a mutation in CTSC, increases the risk of pyogenic infections in PLS patients. A child with PLS is presented here with liver abscesses and peritonitis caused by Rhizopus oryzae. His liver abscess and peritonitis were cured with amphotericin B without surgical care. This is the first case in the literature liver abscess due to Rhizopus oryzae in a child with PLS.     

Pyogenic liver abscess complicating a ventriculoperitoneal shunt

Pyogenic liver abscess is a rare complication of ventriculoperitoneal (VP) shunting. We report a 4-month-old female with this complication who was successfully treat ed by computed tomography-guided percutaneous transhepatic catheter drainage, shunt externalization, and parenteral antibiotics. Liver abscess is a possible intra-abdominal complication of VP shunting, and imaging studies are good adjuncts in making the clinical diagnosis. Accepted: 11 November 1996     

Lung abscess due to Mycoplasma pneumoniae in an adolescent]

Pulmonary abscess is an uncommon complication of pneumonia in children. Pyogenes, in particular Staphylococcus aureus or Streptococcus pneumoniae are the principal responsible bacteria. Mycoplasma pneumoniae is rarely the cause. CASE REPORT: A 14-year-old child was hospitalized with right thoracic pain. The patient was non-febrile and had a recent history of moderate infection. He was receiving antibiotic (macrolide) and non-steroidal anti-inflammatory therapy. CT scan confirmed a mid-lobe abscess in the right lung. Interruption of therapy resulted in fever and increase in C-reactive level with hyperleucocytosis, suggesting that the abscess was caused by a bacterial infection. The child's general condition and the radiographic picture improved with combined antibiotic therapy with amoxycillin and clavulanic acid, aminoglycosides and macrolides. The suspected diagnostic of M. pneumoniae was confirmed by increased IgM antibodies for M. pneumoniae. Recovery was complete two months later without sequelae. COMMENT: Pulmonary abscess is a rare complication of M. pneumoniae infection in children. This complication should be considered when the general condition does not improve despite appropriate early treatment of a pneumonia, as in the case of our patient.     

Hepatic abscess: a rare manifestation of brucellosis in children

Hepatic abscess caused by brucellosis is extremely rare in children. We report the case of a 5-year-old girl in whom an abscess of the liver developed during an episode of acute brucellosis. To our knowledge, this is the second reported case of hepatic abscess caused by brucellosis in a child.     

Perforated Meckel’s Diverticulum Presenting as Subphrenic Abscess

MeckePs diverticulum is known to present with myriad complications. However, its perforation followed by development of subphrenic abscess has not been reported in literature. We report this complication in an elevenmonth-old child.     

Pyogenic liver abscess in children: a report of three patients and review of the literature

Three children with pyogenic liver abscess seen over a period of 2 years are reported. Their immune status was normal and no underlying causes were detected. The clinical picture was characterized by fever, abdominal pain and tender hepatomegaly. Abscesses were solitary in two children and multiple in the third. One child died within 12 h of admission, the other two recovered completely. Recent literature on pyogenic liver abscess is reviewed.     

Mal-positioned umbilical venous catheter causing liver abscess in a preterm infant

Neonatal liver abscess is uncommon, carries a high mortality and is difficult to diagnose. We report an unusual case of liver abscess in a preterm infant presenting with abdominal distension and suspected gastrointestinal perforation, rather than the more usual features of fever, hepatomegaly, abdominal tenderness, right-sided pleural effusion, and leukocytosis. We discuss current treatments for neonatal liver abscess and argue that in view of the high mortality and difficulty in diagnosis, prevention should be the primary objective. We believe that mal-positioning the umbilical venous catheter in the liver substantially increases the life-threatening risk of this complication, and advocate extreme care in the placement and use of these catheters.     

Views of parents of children with sickle cell disease on pre‐implantation genetic diagnosis

Pre‐implantation genetic diagnosis (PGD) is an option for parents who have a child with sickle cell disease (SCD) to have another child without SCD. We conducted a survey of 19 parents with at least one child with SCD to investigate views on PGD. Before education, 44% of parents were aware of PGD. All parents rated PGD education as important. All parents considering another child also reported interest in using PGD if insurance covered its costs. Parents who have a child with SCD appear to be interested in PGD and educational tools informing this group about PGD should be developed.     

Portal vein thrombosis complicating neonatal hepatic abscess

Hepatic abscess in a neonate is a rare but serious disorder. Diagnosis of hepatic abscess requires a high index of suspicion in any septic neonate. CT scan and ultrasound of liver are the most sensitive diagnostic tests in detection of hepatic abscess. Portal vein thrombosis and portal cavernoma formation is hitherto unreported complication of neonatal hepatic abscess in English literature. Present case report highlights the difficulty in diagnosis of neonatal hepatic abscess and describes the development of portal vein thrombosis and cavernoma during its treatment.     

Crohn’s disease : Disastrous consequences of late diagnosis

Chronic and recurrent perianal abscess is an uncommon condition in children. Tuberculosis is thought to be the common etiology for such a presentation in India. We report a case of a child with colonie and perianal disease due to Crohn’s disease and emphasize the disastrous complication due to delayed diagnosis     

Papillon-Lefèvre syndrome: report of three cases in the same family

Papillon-Lefèvre syndrome is a rare autosomal recessive disorder caused by cathepsin C gene mutation leading to the deficiency of cathepsin C enzymatic activity. The disease is characterized by palmoplantar hyperkeratosis, periodontopathy and precocious loss of dentition, and increased susceptibility to infections. Pyogenic liver abscess is an increasingly recognized complication. Three cases of Papillon-Lefevre syndrome in the same family are presented here. Two of the three siblings presented with characteristic manifestations of the syndrome. The third case had died previously due to liver abscess prior to a diagnosis of Papillon-Lefèvre syndrome.     

Liver abscess in a newborn leading to portal vein thrombosis

We report a male neonate who had liver abscess that resolved with intravenous antibiotics and surgical drainage. However, the child developed complete thrombosis of portal vein with cavernous formation within 16 days of therapy and portal hypertension subsequently. The child is now 2 1/2 years and has extra hepatic portal hypertension but is otherwise asymptomatic.     

Laparoscopic liver biopsy using cup-shaped punch biopsy forceps and argon beam coagulator in children

Needle liver biopsy is insufficient for measuring enzyme activity in liver tissue in child cases of intrahepatic cholestasis because the biopsy specimen obtained is too small. This study was undertaken to validate the feasibility of a new, relatively non-invasive laparoscopic liver biopsy technique combining the use of laparoscopic cup-shaped punch biopsy forceps (CPBF) and an argon beam coagulator (ABC™) handpiece for the diagnosis and examination of liver enzyme activity in cases of intrahepatic cholestasis in children. The authors performed laparoscopic liver biopsy with the combined use of laparoscopic CPBF and an ABC™ handpiece in 10 children aged 4 months to 9 years old. Two 5-mm trocars were inserted in each patient after their abdomens had been filled with carbon dioxide gas at a pressure of 8 mmHg. Four to five specimens (each: 0.5 cm³ in size) were taken at the anterior edge of the left lobe of the liver using laparoscopic CPBF. ABC™ was sprayed on to the cut liver surface to achieve hemostasis. The duration of the laparoscopic procedure ranged from 25 to 64 (44 ± 12.8) min. The maximum intraoperative hemorrhage from the biopsied liver bed was 30 ml. The bleeding was easily controlled using ABC™ for about 1 min. There were no cases of postoperative bleeding, bile leakage from the cut surface, nor intraabdominal infection. There were also no death cases, and only one complication (hydrocele testis) was recorded. Examination by microscopy and assays of enzyme activities were performed using these biopsy specimens, which were sufficient for diagnosis in all patients. Laparoscopic liver biopsy combining the use of laparoscopic CPBF and an ABC™ handpiece can be performed safely, is less invasive, and provides sufficient samples for examination both by microscopy and enzyme activity assays.     

Sudden-onset blindness in sickle cell disease due to retinal artery occlusion

Central retinal artery occlusion (CRAO) is a rare and potentially devastating cause of acute blindness in sickle cell disease (SCD) that is unique compared to classic sickle retinopathy. Few details related to this complication in SCD are known, including its risk factors, pathogenesis, presentation, treatment and outcomes. We present three patients with SCD and retinal artery occlusion. The overall variability in clinical presentation, treatment and prognosis reported in the literature underscores the need for a greater understanding of these factors as they relate to this complication in SCD.     

Cholecystectomy in children with sickle-cell disease

Cholelithiasis is a common complication of sickle-cell disease (SCD); its frequency is variable, ranging from 4% to 55%. Twenty-two children with SCD (Hb SS) underwent cholecystectomy for cholelithiasis. All were managed with a preoperative transfusion regimen to achieve a hemoglobin concentration of 10–12 g/dl and a hematocrit of 30%–40%. On the evening before surgery, each patient was hydrated with IV fluids (5% dextrose in 1/2 or 1/4 normal saline) at 1.5 times the maintenance rate and postoperatively they received IV morphine infusions for analgesia. Intraoperative cholangiograms revealed common bile duct (CBD) stones in 7 patients (30%), only 4 of which were detected preoperatively by ultrasound (US). Two patients also had a splenectomy together with the cholecystectomy, 1 for a splenic abscess and the other for recurrent sequestration crises. There was no mortality, but 2 patients developed acute chest syndrome, 1 developed a minor wound infection, and 1 had postoperative bleeding from the splenic bed. Careful perioperative management permits safe cholecystectomy in children with SCD. Routine intraoperative cholangiography is recommended in these cases, as while 7 of our patients had CBD stones, only 4 of them were detected preoperatively by US.     

Hemobilia complicating a liver abcess

We present the case of an 11-year-old female, with a history of colicky pain abdomen fever, and episode of massive hematemesis and melena. The child was presented to the medical emergency with features of shock. Coagulation profile of the child was normal. Ultrasonography demonstrated multiple liver abscess. Repeated endoscopies ruled out the possibility of gastric or upper gastrointestinal causes of bleed where in the possibility of hemobilia, was considered. Endoscopic retrograde cholangiography demonstrated the presence of bleeding from the biliary tract. Angiography demonstrated the presence of the communication of the biliary radicles with the hepatic vessels and also aided with therapeutic embolization. Hemobilia is a rare cause of upper gastrointestinal hemorrhage with an increasing incidence because of the widespread use of invasive hepatobiliary procedures and improved recognition. In the majority of cases the cause is iatrogenic and those associated with the liver abscess are scantily reported in the English literature. Persistent bleeding sometimes requires urgent therapeutic intervention, such as angiography or surgery.     

Cutaneous amebiasis

An infant with cutaneous amebiasis of the vulva and amebic liver abscess is described. Epidemiologic investigations and serologic studies were crucial in establishing the diagnosis. The vulvar amebic ulcers responded dramatically to metronidazole therapy. Cutaneous amebiasis is a rare complication of Entamoeba histolytica infection which should be considered in the differential diagnosis of perineovulvar or penile ulcers. Cutaneous amebiasis may also occur on the abdominal wall surrounding a draining hepatic abscess, colostomy site, or laparotomy incision.     

Renal abscess in Papillion–Lefèvre syndrome

A 5-year-old female with Papillon–Lefèvre syndrome presented with renal mass. A radiological diagnosis of malignancy was made; however, partial nephrectomy revealed granulomatous disease indicative of chronic infection. Although liver abscess is an emerging complication in patient with Papillon–Lefèvre syndrome, this case represents the first renal abscess described in such patients.