A Case of Pyogenic Liver Abscess After an Operation for Acute Appendicitis in a Child

Takeshi Takashima, Masaki Kawamoto, Tadashi Oku^* and Koichi Hirata

First Department of Surgery, Sapporo Medical University School of Medicine, Department of Surgery Hokkaido Prefectural Esashi Hospital^*

An 8-year-old boy was admitted to our hospital because of nausea and a right lower abdominal pain. The patient was diagnosed as having acute appendicitis, and an emergency laparotomy was performed. An appendectomy and drainage of the abdominal cavity was conducted. On the 5^th postoperative day, the boy developed a temperature of 40.0'C. A computed tomography (CT) examination showed a subcutaneous abscess caused by a wound infection. Open drainage was performed, and the patient became afebrile. However, a high fever recurred on the 8^th postoperative day. On the 13^th postoperative day, a CT examination showed a pyogenic abscess, measuring 13 cm in diameter, in the right lobe of the liver. US-guided percutaneus catheter drainage of the liver abscess was immediately performed. About300ml of the purulent fluid was drained, and a γ-streptococcus species was isolated. After 14 days of drainage, the abscess cavity of the liver resolved and the drainage catheter was removed. The patient remained febrile for two weeks, but his clinical symptoms gradually improved and he was discharged on the 46^th postoperative day. Only a few reports of pyogenic liver abscesses after an operation for acute appendicitis during childhood have been made.

Key words
acute appendicitis, liver abscess

Reprint requests
Takeshi Takashima First Department of Surgery, Sapporo Medical University, School of Medicine South 1, West 16, Chou-Ku, Sapporo, 060-8556 JAPAN

Accepted
September 19, 2001

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