U Dhir, S Singhvi, S Rawat. Sir Ganga Ram Hospital, New Delhi
Introduction: There is a high incidence of pyogenic and amebic liver abscesses in the developing world. Caudate lobe is both a rare and peculiar location in view of vicinity to vascular structures and difficult percutaneous and laparoscopic approach. We report 4 cases of pyogenic caudate lobe liver abscesses which were treated by laparoscopic drainage.
Methods: The diagnosis was confirmed with a contrast enhanced computerized tomographic scan (CECT) of abdomen. The patients were taken up for laparoscopic drainage as percutaneous approach was either not feasible (n=3) or failed (n=1) and the patients were taken up for a laparoscopic drainage. All patients underwent successful laparoscopic drainage of caudate abscess. Three ports along with Nathanson’s retractor was used. The gastrohepatic omentum approach was followed. The location of abscess was confirmed intraoperatively with needle aspiration and laparoscopic ultrasound. Harmonic scalpel was used to enter the abscess cavity and create a wide window. A drain was placed in the cavity under vision after irrigation.
Results: All the patients were male and had underlying diabetes. The mean WBC count was 22000 at presentation and normalized in 3 days after drainage. The mean operative time was 67.5 minutes (range 55-90 minutes). Estimated intraoperative blood loss was less than 100 ml in all cases. The mean hospital stay was 7 days (range 5-9 days). The drain was removed on day 5 after documentation of no residual abscess in all. All patients were switched to oral antibiotics after drain removal. Follow up CT was performed 4 weeks postoperatively to confirm complete resolution.
Conclusion: Caudate lobe liver abscesses are rare but are difficult to drain by percutaneous route. Early surgical drainage (open/laparoscopic) is recommended in view of high risk of rupture in abdominal cavity and adjacent vessels.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79924
Program Number: P463
Presentation Session: Poster (Non CME)
Presentation Type: Poster
