Amebic liver abscess Spare the knife but save the child

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1、AmebicLiverAbscess:SparetheKnifeButSavetheChildByF.MoazamandZ.NazirKarachi,PakistanBackground/Purpose:Amebicliverabscess(ALA),themostcommonextraintestinalmanifestationofinfectionwithEnt-amebahistolytica,carriessignificantmorbidityandmortalityinthepediatricagegroup.Theefficacyofmetronidazoleinthet

2、reatmentofALAiswellestablished,buttheroleofsurgicalinterventionremainscontroversial.ManyinvestigatorsstilladvocateaggressivesurgicaltherapyforcomplicatedandrupturedALA.ReportsregardingmanagementofALAinchildrenaresparseanddealwithsmallnumbersofpatients.Theobjectiveofthisstudywastoassesstheeffect

3、ivenessofparenteralmetronidazolecombinedwithjudiciousaspirationofALAinobviatingtheneedforsurgicalintervention.Methods:ThemedicalrecordsofallchildrenadmittedwiththediagnosisofALAbetween1986and1997totheAgaKhanUniversityHospitalwerereviewedretrospectively.ThediagnosisofALAwasconfirmedin48patientsby

4、anultrasoundscantogetherwithelevatedindirecthemagglutination(IHA)titres(>250}.Agesrangedfrom3weeksto14.5years.Resuits:Thirty-seven(75%)childrenwerebelowthefifthpercentileforheightandweight,and45(93.7%)presentedwithahemoglobinleveloflessthan10.0g/dL.Comorbidfactorsincludedpulmonarytuberculosis{n二2

5、,chickenpox(n==1}rtetralogyofFallot(n=1},andthalassemiamajor(n=2).Therewasameandelayof13daysbeforepresentationtothehospital.Allpatientsweretreatedwithparenteralmetronidazoleandbroad-spectrumantibiotics.Thelatterwerediscontinuedonconfirmationofthediagnosis.Thedurationoftreatmentwithmetronidazoler

6、angedfrom2to5weeks.PercutaneousaspirationoftheALAwasperformedunderultrasoundguidanceusingsedationin28patientsforoneormoreofthefollowingindications;ALAgreaterthan7.0cms(n=20),leftlobeinvolvement(n=8),andnoresponseafter48hoursofmedicaltherapy(n-6).Ninepatientsrequiredmorethanoneaspiration.Onepatien

7、twithperitonealruptureoftheALAadditionallyunderwentpercutaneousaspirationoftheperitonealcavityunderultrasoundguidance.OnepatientrequiredinsertionofachesttubeafterruptureoftheALAintotherightpleuralcavity,andanotherund