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J Gastroenterol 2007; 42:236240 DOI 10.1007/s00535-006-1989-5
Ascaris liver abscess in children
Shamsul Bari, Khurshid A. Sheikh, Mohammad Ashraf, Zahoor Hussain, Asif Hamid, and Gowhar Nazir Mufti
Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
Background. Liver abscess in childhood is a very challenging subject both for patients and doctors. In India, pyogenic liver abscesses have been found mostly in children, especially in rural areas. Liver abscess due to wandering ascarids is a common complication in children in Kashmir, although it is rare outside. Methods. The study was carried over a period of 10 years at Sheri-Kashmir Institute of Medical Sciences Srinagar India. Ten cases of liver abscesses due to wandering ascarids in children were encountered. The children were aged 2 years to 13 years. Results. 70% of the children were from rural areas. All ten patients presented with fever, while three patients presented with peritonitis. Ultrasonography was the main tool of diagnosis. All ten patients were managed by open surgical drainage. Conclusion. We conclude that Ascaris infestation should always be kept in mind while dealing with liver abscess in children.
Key words: Ascaridal liver abscess, peritonitis, open drainage
Introduction
Ascaris liver abscess is one of the serious complications of wandering ascarids, and the clinical diagnosis of the condition is very difcult.1,2
Conditions such as achlorhydria, antihelminthic treatment, and rise of the hosts temperature have been mentioned to be responsible for causing migration of these nematodes into the biliary system.1 Invasion of the biliary tract leads to purulent cholangitis and, nally, liver
abscess.1 The adult worm itself may reach the liver and cause liver abscess. Ascaris during migration may carry intestinal ora, particularly Escherichia coli, thereby causing secondary infection of abscess. A predisposition to ascardial abscess is favored by several factors, which include poor socioeconomic status, lack of health education, poor sanitation, and unclean habits of children.3
Subjects and methods
The study was conducted at the Department of Paediatric Surgery of Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India, both retrospectively and prospectively. Children in the age group of 213 years during a period of 10 years from January 1991 to December 2000 were included in the study.
The retrospective study was conducted from the case records of patients provided by...