Chun-Yu Chen1, Mao-Jen Lin2, Wen-Chieh Yang1, Yu-Jun Chang3, Feng-Xia Gao4, Han-Ping Wu5. 1. Department of Pediatric Emergency Medicine, Children's Hospital, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. 2. Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; Department of Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan. 3. Laboratory of Epidemiology and Biostatistics, Changhua Christian Hospital, Changhua, Taiwan. 4. Department of Medical Research, Children's Hospital, China Medical University, Taichung, Taiwan. 5. Department of Pediatric Emergency Medicine, Children's Hospital, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, Children's Hospital, China Medical University, Taichung, Taiwan; Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: arthur1226@gmail.com.
Abstract
BACKGROUND: To analyze clinical spectrum of intra-abdominal abscesses in children and find helpful clinical parameters could aid physicians in earlier detection and differential diagnosis. METHODS: From 2004 to 2011, we retrospectively analyzed 66 pediatric patients, aged 18 years or younger with intra-abdominal abscesses. The data were obtained and studied: demographics, clinical presentations, etiologies, laboratory tests, microbiology, imaging studies, treatment modalities, complications and long-term outcomes. RESULTS: There were 66 patients (mean age, 9.27 ± 4.16 years) diagnosed as intra-abdominal abscesses. The two most common presented symptoms were fever and abdominal pain (90.9%; 78.8%, respectively). Most patients presented with leukocytosis (81.8%) and elevated C-reactive protein (CRP) levels (95.5%). In patients with abscesses in solid organs, urine white blood cell counts, nitrate and leukocyte esterase were all significant parameters (all P < 0.05), and urine pH and specific gravity were both lower than those in non-solid organs (P = 0.026; P = 0.043, respectively). Escherichia coli (E. coli) was the most common organism cultured from renal abscess. Streptococcus viridans was the most common organism cultured from liver abscess. Moreover, the two most predominant bacteria in periappendical and intraperitoneal abscesses were E. coli and Bacteroides fragilis. CONCLUSIONS: We suggest that primary physicians should keep this disease in mind when children present with predisposing risk factors, fever, abdominal pain, leukocytosis and elevated CRP level. Besides, we recommend the urinary analysis or ultrasonography (US) is valuable in patients with fever and abdominal pain.
BACKGROUND: To analyze clinical spectrum of intra-abdominal abscesses in children and find helpful clinical parameters could aid physicians in earlier detection and differential diagnosis. METHODS: From 2004 to 2011, we retrospectively analyzed 66 pediatric patients, aged 18 years or younger with intra-abdominal abscesses. The data were obtained and studied: demographics, clinical presentations, etiologies, laboratory tests, microbiology, imaging studies, treatment modalities, complications and long-term outcomes. RESULTS: There were 66 patients (mean age, 9.27 ± 4.16 years) diagnosed as intra-abdominal abscesses. The two most common presented symptoms were fever and abdominal pain (90.9%; 78.8%, respectively). Most patients presented with leukocytosis (81.8%) and elevated C-reactive protein (CRP) levels (95.5%). In patients with abscesses in solid organs, urine white blood cell counts, nitrate and leukocyte esterase were all significant parameters (all P < 0.05), and urine pH and specific gravity were both lower than those in non-solid organs (P = 0.026; P = 0.043, respectively). Escherichia coli (E. coli) was the most common organism cultured from renal abscess. Streptococcus viridans was the most common organism cultured from liver abscess. Moreover, the two most predominant bacteria in periappendical and intraperitoneal abscesses were E. coli and Bacteroides fragilis. CONCLUSIONS: We suggest that primary physicians should keep this disease in mind when children present with predisposing risk factors, fever, abdominal pain, leukocytosis and elevated CRP level. Besides, we recommend the urinary analysis or ultrasonography (US) is valuable in patients with fever and abdominal pain.