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Primary Liver Abscesses in Children and Adolescents

Twelve cases of liver abscess in children and adolescents presenting at Children's Hospital at Los Angeles from 1974 to 1983 were reviewed. Most occurred in children younger than 5 years of age. The time from onset of symptoms to presentation did not differ over the 10-year period examined. However, diagnosis was made more rapidly in the latter half of the decade due to the development of advanced noninvasive imaging techniques and serologic methods. A constellation of fever, abdominal pain (whether or not localized in the right upper abdomen), vomiting or anorexia, hepatomegaly, elevated white blood cell count and sedimentation rate, and an unexplained anemia should prompt the clinician to include occult liver abscess in the differential diagnosis and proceed to early use of ultrasound or isotopic liver-spleen scan. History of travel or immigration or exposure to food handlers harboring the infection is important to differentiate amebic abscess from bacterial abscess. This suspicion may greatly alter the course of treatment.