Pyogenic liver abscess in children: is ruptured appendix still relevant as cause? Case report

Pyogenic liver abscess [PLA] is a rare and life-threatening disease in children. Appendicitis was the leading source of PLA in the pre-antibiotic era, but it essentially has been eliminated in recent times. Most patients with persistent fever after exploratory laparatomy for perforated appendicitis are often found to have residual abdominal collection. We report a 12-year old girl with PLA after laparotomy for perforated appendix. She developed persistent fever and respiratory distress post operatively. Physicians had an impression of pneumonia but abdominal ultrasound showed cystic mass with mobile internal echoes within the right lobe of the liver suggesting an abscess. Patient was successfully managed by percutaneous drainage under ultrasound guidance. Culture of the pus yielded no growth. She was discharged after 7 weeks of hospital stay. Aetiology, evaluation and treatment modalities were reviewed.

The relationship between gallstone disease and gall bladder volume

BACKGROUND

The role of a large gallbladder volume with regards to a predisposition to gallstones is unknown. It is likely that an increase in gallbladder volume could result in impaired gallbladder motility and bile stasis which may encourage gallstone formation. This study is therefore to determine the relationship between the presence of gallstone disease and gall bladder volume.

METHODOLOGY

One hundred type 2 diabetic patients and 100 age and sex-matched controls underwent real time ultrasonography to determine the relationship between the presence of gallstone disease and gallbladder volume. Their demographic characteristics were recorded and compared. The ultrasound examinations was done in the morning following an overnight fast (to prevent gall bladder contraction) without sedation. Longitudinal and transverse scans of the right upper quadrant was done in both the supine and left lateral positions The gallbladder volume was measured.

RESULT

The mean gallbladder volume in diabetic patients with gallstone disease 28.4 +/- 18.6 ml was higher than in those without gallstone disease 27.4 +/- 14.8 ml p = 0.844. The mean gallbladder volume in the controls with gallstone disease 26.5 +/- 14.7 ml was also higher than in those without gallstone disease 24.1 +/- 12.7 ml p = 0.189.

CONCLUSION

The fasting gallbladder volume tended to be larger in patients with gallstones (i.e. both diabetic patients and controls).

Current views on ultrasonography in the management of pyogenic liver abscess-challenge to practitioners in sub-Saharan Africa

The aim of this review of the recent literature on the current practice in the management of pyogenic liver abscess (PLA) is to highlight the important roles radiological procedures, particularly ultrasonography (US) now play in it. US equipment is now widely available in many African nations, yet not much is being done to embrace this current line of management. This is evidenced by the dearth of published work in this area from especially sub-Saharan Africa. It is being suggested that general surgeons and radiologists in this region collaborate more to reduce the cost of treating all cases by operations.