Although amebic liver abscess can be a cause of significant morbidity and mortality in all ages, there are few reports dealing with this entity in children. Twenty-four children with amebic liver abscess, ages ranging between 8 weeks and 14.5 years were managed at the Tehran University Hospital of Children, Iran, between November 1987, and October 2001. The most frequent presentation was high grade fever and right upper quadrant pain, associated with tender hepatomegaly, leukocytosis and an elevated erythrocyte sedimentation rate. The diagnosis was confirmed by elevated indirect hemagglutination titers and ultrasonography of the liver. Unlike the experience in adult patients, none of the patients had concomitant jaundice and significant derangement of liver enzymes. The abscesses were likely to be solitary (22 of 24 patients). There were 17 males and 7 females. Most patients (80%) were between 8 weeks to 14.5 years of age. In five patients possible predisposing factors were tuberculosis, chickenpox, tetralogy of fallot and thalassemia major. All patients received metronidazole (50 mg/kg/day), followed by a therapeutic course of a luminal amebicide. There were no deaths despite a mean delay of 15 days before presentation to our hospital. In conclusion a high index of suspicion, early institution of metronidazole therapy and aspiration of abscesses with potential to rupture are believed to have contributed to the better outcome in these children when compared with results in previous reports.

Background: Historically open surgical drainage has been the treatment of choice for pyogenic liver abscess. The records of 54 patients with pyogenic liver abscess were reviewed to determine whether earlier diagnosis with current imaging tests and definitive treatment with antibiotics and aspiration drainage was an effective alternative to surgery.Methods: The clinical features, laboratory tests, imaging, and microbiologic findings, management strategy and final outcome were studied.Results: Twenty-nine patients were treated with broad-spectrum antibiotics and diagnostic aspiration. Twenty-three (79%) recovered uneventfully, and six required catheter or operative drainage. Twenty-three patients (including five who failed aspiration) underwent drainage with percutaneusly placed catheters. Nineteen (83%) recovered, four required open drainage, and of seven patients who required open drainage, six recovered. One (2%) of the 54 patients died following failed aspiration and catheter and surgical drainage. Four patients were successfully treated with antibiotics alone without aspiration.Conclusion: This study confirms that pyogenic liver abscess can be successfully treated with broad spectrum antibiotics and aspiration or percutaneous catheter drainage. Open surgical drainage is reserved for patients in whom treatment fails or who require celiotomy for concurrent disease.

Pyogenic liver abscess (PLA) is a rare but serious condition that can be life-threatening. Recent developments in diagnostic techniques and treatment have resulted in earlier detection and intervention and hence reduction in mortality rates. Despite these improvements, PLA remains a clinical challenge due to its hidden symptoms and associated health risks. PLA may be caused by seeding from appendicitis. We present a 52-year-old woman presented with PLA due to appendicitis. Upon physical examination, laboratory study and imaging, an acute appendicitis with pyogenic liver abscess were found. The patient underwent percutaneous drainage of the abscesses with a catheter and an interval appendectomy.

Background: Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most frequently used thermal ablation methods for the treatment of liver cancer. Liver abscess is a common and severe complication of thermal ablation treatment.Objectives: The objective of this study was to determine the incidence and risk factors of liver abscess formation after thermal ablation of liver cancer.Materials and Methods: The clinical data of 423 patients who underwent 691 thermal ablation procedures for liver cancer were collected in order to retrospectively analyze the basic characteristics, incidence, and risk factors associated with liver abscess formation.Patients with multiple risk factors for liver abscess formation were enrolled in a risk factor group, and patients with no risk factors were enrolled in a control group. The chi-square test and multiple logistic regression analysis were used to analyze the relationship between the occurrence of liver abscesses and potential risk factors.Results: Two hundred and eight patients underwent 385 RFA procedures, and 185 patients underwent 306 MWA procedures. The total incidence of liver abscesses was 1.7%, while the rates in the RFA group (1.8%) and MWA groups (1.6%) were similar (P>0.05). The rates of liver abscesses in patients who had child-pugh class B and class C cirrhosis (P=0.0486), biliary tract disease (P=0.0305), diabetes mellitus (P=0.0344), and porta hepatis tumors (P=0.0123) were 4.0%, 6.7%, 6.5%, and 13.0%, respectively. There was a statistically significant difference between these four groups and the control group (all P<0.05). The incidence of liver abscesses in the combined ablation and percutaneous ethanol injection (PEI) group (P=0.0026) was significantly lower than that of the ablation group (P<0.05).Conclusions: The incidence of liver abscesses after liver cancer thermal ablation is low. Child-Pugh Class B and Class C cirrhosis, biliary tract disease, diabetes mellitus, and porta hepatis tumors are four significant risk factors. Combined ablation and PEI reduces the rate of liver abscesses.