Subhepatic Klebsiella Appendicular Abscess Presenting as A Vague Abdominal Pain in a 10-Year-Old Girl: A Case Report

A 10-year-old girl presented to the outpatient clinic with complaints of vague diffuse abdominal pain with nausea and vomiting for one day not associated with change in bowel habits, fever or jaundice. On day 3, the patient returned to outpatient clinic with improvement in nausea but persistence in the diffuse abdominal pain. She started developing fever spikes. Laboratory investigations revealed elevated total leukocyte count with otherwise normal routine. Typhidot, Widal, Hepatitis A and Dengue antigens were negative. Intravenous antibiotics of ceftriaxone 1 gram and amikacin 250 milligram per day in divided doses were started. On day 5, fever spikes continued and abdominal pain was localised to right upper quadrant. Tenderness in right upper quadrant was noted. An ultrasonography of abdomen was requested which showed a ill-defined hypo-echoic mass in the right upper quadrant was noted. A computed tomography scan of abdomen showed a perforated retrocecal and sub hepatic appendicitis with abscess formation. Surgical gastroenterology review was obtained. A diagnostic peritoneal lavage and drainage was done which showed about 100 ml of pus in the sub hepatic space. 24F drain was placed. IV Cefaperazone sulbactam and metronidazole were started. On Day 12 review ultrasound of abdomen showed no focal collection or bowel wall thickening. Surgical gastroenterology review was obtained and patient was found fit to be discharged.