Successful Use of Tissue Plasminogen Activator in an Adolescent Male with Pyogenic Liver Abscess

Large pyogenic liver abscess is a rare and difficult to treat entity in pediatric patients. Percutaneous drainage rather than open surgical drainage has become more common in recent years, even for large abscesses. Percutaneous drainage can be complicated by catheter obstruction. We present the case of a 16-year-old male presenting with abdominal pain, fever, and chills. He was diagnosed with a 9-centimeter liver abscess. A CT-guided percutaneous drainage was placed. The catheter initially drained well, but then became occluded. Tissue plasminogen activator was instilled into the catheter every 6 hours for a total of five doses, resulting in increased drainage and improved clinical state of the patient. To our knowledge, this is the first reported use of tissue plasminogen activator in pyogenic liver abscess in the pediatric population.

[1]  H. Shah,et al.  Management of Liver Abscess in Children: Our Experience , 2017, Euroasian journal of hepato-gastroenterology.

[2]  D. Kim,et al.  Klebsiella pneumoniae liver abscess in an immunocompetent child , 2013, Korean journal of pediatrics.

[3]  D. Gervais,et al.  Use of Fibrinolytics in Abdominal and Pleural Collections , 2012, Seminars in Interventional Radiology.

[4]  Michael F Cellucci,et al.  Microbiology and Management of Pediatric Liver Abscesses: Two Cases Caused by Streptococcus anginosus Group , 2012, Case reports in infectious diseases.

[5]  J. Langer,et al.  The role of tissue plasminogen activator in the management of complex intra-abdominal abscesses in children. , 2012, Journal of pediatric surgery.

[6]  T. Pruett.  Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection , 2012 .

[7]  R. Davies,et al.  Intrapleural use of tissue plasminogen activator and DNase in pleural infection. , 2011, The New England journal of medicine.

[8]  H. Heneghan,et al.  Modern management of pyogenic hepatic abscess: a case series and review of the literature , 2011, BMC Research Notes.

[9]  L. Jacks,et al.  Current management of pyogenic liver abscess: surgery is now second-line treatment. , 2010, Journal of the American College of Surgeons.

[10]  T. Mckenzie,et al.  Pyogenic liver abscess secondary to Streptococcus anginosus in an adolescent. , 2010, Journal of pediatric surgery.

[11]  Sang Woo Park,et al.  A case of pyogenic liver abscess in a 10-year-old girl , 2010, Korean journal of pediatrics.

[12]  P. Hahn,et al.  Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome? , 2009, Journal of vascular and interventional radiology : JVIR.

[13]  J. Hom,et al.  Pediatric pyogenic liver abscess. , 2009, Pediatric emergency care.

[14]  D. Iannitti,et al.  Optimal Treatment of Hepatic Abscess , 2008, The American surgeon.

[15]  G. Lauwers,et al.  Liver Disease in Children: Bacterial, Parasitic, and Fungal Infections of the Liver , 2007 .

[16]  C. Macarthur,et al.  Effectiveness and safety of tissue plasminogen activator in the management of complicated parapneumonic effusions. , 2004, Pediatrics.

[17]  T. Gerstle,et al.  Tissue plasminogen activator for the treatment of intraabdominal abscesses in a neonate. , 2003, Journal of pediatric surgery.

[18]  J. Hernández,et al.  Pyogenic hepatic abscess: clues for diagnosis in the emergency room. , 2001, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[19]  B. Bailey,et al.  Hepatic abscess: Current concepts in diagnosis and treatment. , 2001, Current surgery.

[20]  S. Srinivasan,et al.  Pyogenic liver abscess in children--South Indian experiences. , 1998, Journal of pediatric surgery.

[21]  K. Lillemoe,et al.  Pyogenic hepatic abscess. Changing trends over 42 years. , 1996, Annals of surgery.

[22]  P. Sheedy,et al.  Treatment of pyogenic hepatic abscesses. Surgical vs percutaneous drainage. , 1986, Archives of surgery.

[23]  C. Stolar,et al.  Pediatric hepatobiliary disease. , 1985, The Surgical clinics of North America.