article · Asian Journal of Pediatric Research
A seven-year-old boy developed multiple presumed pyogenic liver abscesses shortly after undergoing an appendectomy for acute appendicitis initially documented as uncomplicated. Presenting five days post-surgery with severe anaemia, elevated inflammatory markers, and fever, imaging revealed multiple liver and pericholecystic collections, peritoneal effusion, hepatosplenomegaly, and a portal cavernoma. Because cultures were negative and abscess drainage was deemed unsafe due to the risk of hepatic rupture, initial empirical antibiotics were escalated to intravenous imipenem, vancomycin, and metronidazole, alongside heparin and enteral nutrition. Four weeks of intravenous antimicrobial therapy produced significant clinical and radiological improvement, alongside reduced inflammatory markers. Subsequent thrombophilia screening identified reduced protein C activity. This clinical case illustrates that persistent postoperative symptoms after uncomplicated appendicitis warrant imaging, and prolonged medical therapy can succeed when drainage cannot be safely performed.
Appendicitis-associated liver abscesses are exceptionally rare in paediatric patients, particularly following cases recorded as uncomplicated. This case highlights that severe abdominal complications can still develop after routine procedures. It also demonstrates that prolonged, carefully monitored antimicrobial therapy can serve as an effective management strategy when surgical drainage carries severe risks such as organ rupture.
The abstract does not indicate an application pathway, as it presents a retrospective single-patient clinical case report.
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Aims: To describe multiple presumed pyogenic liver abscesses developing shortly after appendectomy for acute appendicitis reported as uncomplicated in a child, and to highlight diagnostic uncertainty, portal venous findings, and management when drainage is considered unsafe. Presentation of Case: A 7-year-old boy was admitted five days after appendectomy with fever, abdominal pain, and deterioration of his general condition. Haemoglobin was 3.5 g/dL, requiring red blood cell transfusion; white blood cell count was 24,800/mm³ and C-reactive protein was 261 mg/L. Ultrasonography and computed tomography showed multiple hepatic and pericholecystic collections, peritoneal effusion, hepatosplenomegaly, and portal cavernoma. Blood and ascitic fluid cultures were negative, and no abscess material was obtained for culture. After one week of a third-generation cephalosporin, an aminoglycoside, and metronidazole, fever and inflammation persisted; repeat computed tomography showed enlargement of the collections with capsular disruption. Treatment was escalated to intravenous imipenem, vancomycin, and metronidazole; heparin and enteral nutritional support were also initiated. Drainage was considered unsafe by the treating team because of concern for hepatic rupture. Intravenous antimicrobial therapy was continued for four weeks, with clinical and radiological improvement and a decrease in C-reactive protein to 60 mg/L. Portal cavernoma was already present on the initial imaging, and thrombophilia screening later showed reduced protein C activity. Discussion: Appendicitis-associated liver abscesses are rare in children and are usually reported with perforated appendicitis or pylephlebitis. In this child, the appendicitis had been reported as uncomplicated, making the temporal association unusual. Because no abscess material was obtained, the pyogenic nature of the lesions remained presumptive. The chronology and significance of the portal cavernoma could not be established in the absence of previous imaging. Conclusion: Persistent postoperative fever and abdominal symptoms should prompt abdominal imaging even after apparently uncomplicated appendicitis. When drainage is considered unsafe, prolonged antimicrobial therapy with close clinical and radiological monitoring may be effective in selected patients. A temporal association in a single case does not establish causality.
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DOI: 10.9734/ajpr/2026/v16i10573
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