Skuteczna kontrola chirurgiczna ropni wątroby w trakcie terapii ostrej białaczki limfoblastycznej

Abstract Liver abscess (LA) has become relatively uncommon in the pediatric population in developed countries. The incidence of LA is 3–25:100 000 hospitalized patients. The disease is seen most often in children with congenital or acquired immunosuppression, granulocyte dysfunction, and thrombosis of portal veins following purulent abdominal infections. Children with malignant diseases are exceptional subjects of a variety of complications during anticancer chemotherapy. Since primary and secondary immune suppression, these patients are susceptible to generalized infections and high possible risk of end-organ complications, including multi-organ failure. The objective of this paper is the report of two cases of children with acute lymphoblastic leukemia, whose therapy was complicated by development of liver abscesses. We present surgical management of the disease, pointing out at two different strategies. In both cases of LA we present successful surgical treatment based on marsupialization, transperitoneal drainage, and partial segmental liver resection in one case. Marsupialization is known as the technique used in surgery related to wide opening of abscess wall, evacuation of its content and its partial resection to prevent recurrent abscess formation. In conclusion, presented combined therapy of LA of bacterial etiology has enabled to control infectious complications and further possible sequelae. The decision of such therapy in children with malignant disorders should be individualized with multidisciplinary approach. LA diagnosed in clinical examination, imaging and microbiological analysis require conservative antimicrobial treatment and/or combined with percutaneous or open drainage or even partial resection of the invaded liver parenchyma.