Journal of Family Medicine and Primary Care · 3 authors, 3 centres
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This retrospective study of 19 children with liver abscess in a resource-limited Indian hospital found that fever, right upper quadrant pain, anemia, and elevated CRP were universal features. Malnutrition was present in 89.5% of cases. All children were successfully treated with antibiotics alone or combined with USG-guided aspiration, with zero mortality, demonstrating that surgical intervention can often be avoided even in settings without pediatric surgery.
**Background:** Liver abscess remains a significant cause of morbidity in developing countries, with pyogenic liver abscess (PLA) constituting 80% of cases. Mortality has declined from 40% in the 1980s to under 15% in recent decades, but untreated cases carry 80–100% mortality. There is no established gold standard for management, and treatment must be tailored to available resources. This study aimed to characterize the clinical profile, laboratory parameters, treatment, and outcomes of children with liver abscess in a resource-limited setting in North India.
**Methods:** This retrospective observational cohort study reviewed medical records of all children <16 years diagnosed with liver abscess admitted to a tertiary teaching hospital in the Himalayan foothills of North India over 4 years (2016–2019). Demographic data, clinical features, laboratory investigations (hemogram, CRP, LFT, blood culture, pus culture), ultrasonographic findings, management, and outcomes were documented. Nutritional status was classified using weight-for-age Z-scores. Anemia was defined per WHO age-specific cutoffs. Aspiration was performed when there was no clinical improvement after 48–72 hours, for left lobe abscesses, for large abscesses, when the liver rim around the abscess was <10 mm, or when the abscess increased in size on serial USG. Data were analyzed using descriptive statistics, Chi-square test, and independent t-test; P<0.05 was considered significant.
**Key Results:** Of 21 children identified, 2 were referred for open surgical drainage due to suspected impending perforation and were excluded due to incomplete records, leaving 19 eligible cases. Mean age was 8.4±4.4 years; 7 were male and 12 female (M:F 7:12). Malnutrition was present in 89.5% (17/19): moderate undernutrition in 26.3% (5) and severe undernutrition in 63.2% (12). Fever with chills occurred in 100% (19), right upper quadrant pain in 89.5% (18), vomiting in 36.8% (7), and pleural effusion in 31.6% (6). All patients (100%) had anemia (mean Hb 8.6±0.8 mg/dl) and raised CRP (mean 17.4±8.1 mg/dl). Leukocytosis was present in 84.2% (16). LFT was normal in all except one child (5.2%) with markedly elevated ALT and AST. Viral markers (Hepatitis A, B, C, E) were negative in all. USG showed solitary abscess in 73.7% (14), multiple in 26.3% (5), right lobe involvement in 73.7% (14), left lobe in 26.3% (5), and average abscess volume of 104.5±79.2 cc. Abscess size was >5 cm in 68.4% (13). Blood culture was positive in only 21.2% (4/19): Staphylococcus in 10.4% (2), Pseudomonas in 5.2% (1), and E. coli in 5.2% (1). Pus culture was positive in 12.5% (1/8), growing Pseudomonas. Half (10/19) were managed with antibiotics alone; the other half (9/19) required USG-guided aspiration on 2–3 occasions plus antibiotics. The aspiration group had significantly larger abscesses (mean max dimension 7.1 cm vs. 4.7 cm, P=0.004). All 19 children recovered fully with no mortality.
**Clinical Implications:** This study demonstrates that in resource-limited settings, children with liver abscess can be successfully managed with intravenous antibiotics and USG-guided aspiration when needed, achieving zero mortality. The high prevalence of malnutrition (89.5%) underscores its role as a major predisposing factor. A high index of suspicion is warranted in children presenting with fever, right upper quadrant pain, anemia, and elevated CRP, prompting urgent USG. While surgical management remains necessary for impending perforation, most cases can be managed conservatively or with minimally invasive aspiration, even where pediatric surgery is unavailable. The study is limited by its small sample size, retrospective design, inability to test for primary immunodeficiencies, reliance on USG rather than CT, and low culture yield likely due to prior antibiotic use.