Yorva Sayoeti

Helicobacter pylori Infection in Children with Recurrent Abdominal Pain and Positive Biopsy Findings

Risk factors for Helicobacter pylori (H. pylori) infection include residence in a developing country, poor socio-economic status, overcrowding family, ethnic and genetic predisposition. The diagnosis and management H. pylori have not been satisfied yet; however, there is a problem of increasing H. pylori antibiotic resistance. We reported a case of 8 year-old girl who suffered from H. pylori infection. The diagnosis was made based on history, clinical findings, and laboratory work-up. Suspicion of H. pylori infection was started when she had recurrent abdominal pain. The result of serologic testing for H. pylori immunoglobulin G (IgG) was positive. Endoscopic biopsy revealed the presence of H. pylori. Patient received regimens for first line eradication of H. pylori, i.e. amoxicillin, clarithromycin and omeprazole for two weeks. Afterward, her condition improved markedly without any further complaint. Keywords : Helicobacter pylori, children, recurrent abdominal pain

ABSES HATI PIOGENIK

Abstrak Abses hati piogenik merupakan suatu kondisi yang berat dan mengancam kehidupan dengan angka mortalitas yang tinggi sehingga membutuhkan diagnostik dan terapi yang akurat. Gejala yang paling sering ditemukan adalah nyeri perut bagian atas, hepatomegali, demam tinggi, mual dan muntah. Gejala ini bervariasi sesuai ukuran abses, keadaan umum pasien, adanya penyakit dasar dan komplikasi. Pada sebagian besar kasus, penyakit dasarnya tidak diketahui. Abses biasanya soliter dan terletak di lobus kanan hati. USG dan CT scan abdomen merupakan sarana diagnostik utama. Abses hati piogenik diterapi dengan aspirasi perkutaneus bersamaan dengan antibiotik. Jika gagal, drainase dengan pembedahan dibutuhkan. Dengan adanya terapi invasif yang minimal seperti aspirasi jarum perkutaneus atau drainase kateter yang dipandu secara radiologis serta ketersediaan antibiotik berspektrum luas, pasien jarang membutuhkan tindakan pembedahan saat ini. Kata kunci : abses hati piogenik, aspirasi perkutaneus, drainase bedah Abstract Pyogenic liver abscess (PLA) is a serious, life threatening condition with a high mortality rate that represents a diagnostic and therapeutic challenge. The most common presenting clinical symptoms are upper abdominal pain, tenderness, hepatomegaly, high-grade fever, nausea and vomiting. These features are variable depending upon the size of the abscess, general health of the patient, associated diseases and complications. In majority of the cases, the underlying cause could not be identified. Majority of abscesses are solitary and are noted in the right lobe of liver. USG and CT of the abdomen are the main tools of diagnosis. PLAs are mainly treated by percutaneous aspiration under antibiotic cover. If fails, surgical drainage becomes necessary. However, with the advent of minimally invasive therapy such as image-guided percutaneous needle aspiration or catheter drainage and the availability of broadspectrum antibiotics, patients with PLA nowadays seldom require open surgery for treatment. Key word : pyogenic liver abscess, percutaneous aspiration, surgical drainage

Rupture of esophageal varices due to portal hypertension

Variceal bleeding is the most common cause of serious upper gastrointestinal (UGI) bleeding in children. Most variceal bleeding is esophageal. 1 Hemorrhages from esophageal varices due to portal hypertension are a major cause of morbidity and mortality. There is a 30% mortality rate following an initial episode of variceal hematemesis. Mortality increases to 70% with recurrent variceal hemorrhage. Moreover, the one year survival rate after variceal hemorrhage is often poor (32 to 80%). 2-4 We report a case of esophageal varices rupture caused by portal hypertension, an emergent case in the Pediatric Gastrohepatology division.