Dongmo Miaffo Désiré O E, Chafaaoui Hakima, Assan Beaudelaire Romulus, Mantho Pauline, Ntankeu Prince Parfait
Department of Pediatric Surgery, Gynaeco-Obstetric and Paediatric Hospital, Douala, Cameroon.
Department of pediatric surgery, Teaching Hospital Mohamed VI, ABDELMALEK ESSADI University, Tangier, Morocco.
Int J Surg Case Rep. 2023 Sep;110:108711. doi: 10.1016/j.ijscr.2023.108711. Epub 2023 Aug 24.
Liver abscesses in neonates are rare. Omphalitis is a very rare cause. We report a case of a voluminous neonatal pyogenic liver abscess following omphalitis, successfully managed in our institution.
A 21-day-old full-term female newborn was brought to our institution for progressive febrile swelling of the right hypochondrium. The parents reported umbilical suppuration. Clinical examination confirmed the presence of a mass extending from the epigastric region to the right hypochondrium in a febrile baby with no other abnormalities. Laboratory investigations revealed an elevated C-reactive protein level (64 mg/dl) and hyperleukocytosis (20,800/mm) with neutrophil predominance and normochromic microcytic anemia (hemoglobin 8.2 g/dl). Her first abdominal ultrasound was interpreted as a cyst of the common bile duct. Triple antibiotic therapy with cephalosporin, ampicillin and gentamycin was started, but unsuccessful. Abdominal ultrasound was repeated, revealing a hepatic abscess in segment 8, with a volume of approximately 17 ml. Percutaneous echo-guided drainage was performed and antibiotic therapy was readjusted after identification of the germ (Staphylococcus aureus) with good outcome. The baby was discharged two weeks later. At one month follow-up, the baby was completely asymptomatic.
As neonatal liver abscesses are unusual, they can lead to misdiagnosis. Omphalitis is a very rare cause. Treatment by percutaneous echo-guided drainage is simple and effective.
新生儿肝脓肿较为罕见。脐炎是一种非常罕见的病因。我们报告一例脐炎后发生的巨大新生儿化脓性肝脓肿病例，在我们机构成功得到治疗。
一名21日龄的足月女婴因右季肋部进行性发热肿胀被送至我们机构。父母报告有脐部化脓。临床检查证实，在一名发热的婴儿中，有一个肿块从胃脘区延伸至右季肋部，无其他异常。实验室检查显示C反应蛋白水平升高（64mg/dl）、白细胞增多（20,800/mm），以中性粒细胞为主，以及正细胞正色素性贫血（血红蛋白8.2g/dl）。她的首次腹部超声检查被解读为胆总管囊肿。开始使用头孢菌素、氨苄西林和庆大霉素进行三联抗生素治疗，但未成功。再次进行腹部超声检查，发现8段有一个肝脓肿，体积约为17ml。在确定病原菌（金黄色葡萄球菌）后，进行了经皮超声引导下引流，并调整了抗生素治疗，结果良好。两周后婴儿出院。在1个月的随访中，婴儿完全无症状。
由于新生儿肝脓肿不常见，可能导致误诊。脐炎是一种非常罕见的病因。经皮超声引导下引流治疗简单有效。
