Secondary outcomes
Eighteen studies reported on clinical findings of hepatomegaly;1039/2967 (35.0%) patients were considered to have enlarged livers on clinical palpation. Twenty-one studies reported on clinical findings of splenomegaly,1311/3009 (43.6%) patients were found to have enlarged palpable spleens on clinical examination.
Three studies reported on abdominal ultrasound findings in patients with IM 4,11,24. In a case-control study, Ishibashi et al. found that all nine IM patients had significantly enlarged spleen on ultrasound. However, only three (33.3%) had splenomegaly on clinical examination. Another study found that all 29 patients with IM had enlarged spleen on ultrasound and 16 (55.2%) had enlarged liver24. Clinical findings of splenomegaly and hepatomegaly were 17.2% and 10.3% respectively in that study.
Mazur et al performed USS gallbladder on all IM patients and found 15/181 (8.3%) of children had acute acalculous cholecystitis (AAC). The cohort with AAC reported right upper quadrant pain in addition to the typical clinical symptoms of IM. None required surgical intervention.
No additional interventions were reported in patients who had elevated bilirubin or clinical jaundice. There were no reports of decompensated acute or chronic liver disease among studies that followed patients for complications relating to IM.