Caudate lobe liver abscess: early surgical drainage

The Indian sub continent has a high incidence of both pyogenic and amebic liver abscesses.1 several factors have been implicated for the same but the most significant is the prevalence of poor hygiene, lack of proper sanitation and low socioeconomic status. The advanced imaging has helped in accurate and early diagnosis of these but still pyogenic liver abscesses carry up to 19% risk of mortality. These abscesses can be in any location on liver namely right lobe, left lobe, caudate lobe or multilobar.2 Currently most of these are managed with help of interventional radiology based percutaneous drainage (either ultrasound or CT guided). Surgical treatment is generally offered to patients after failure of percutaneous drainage which not only adds to morbidity and cost of treatment but also delays the therapeutic intervention. There can be several factors for failed percutaneous approach3 but location of abscess is a very important factor. The caudate lobe abscess is one such location which is rare and has a difficult percutaneous access.4 We report 4 cases of caudate lobe liver abscesses which were managed by laparoscopic drainage.