Isolated Caudate Lobe Abscesses – Presentation and Laparoscopic Management

Pawan Kumar, MS, Munish Trehan, MS, Satpal S Virk, MCh. Dayanand Medical College & Hospital, Ludhiana, Punjab INDIA

The caudate lobe with its own independent arterial and venous supply, only rarely is infected. Because of its deep anatomical location and surrounded by major vessels, it is usually inaccessible to percutaneous approach. It is involved in association with rest of the hepatic parenchyma, isolated involvement is very rare. We describe presentation and management of three cases of isolated caudate lobe abscesses.
Patients ( 2 females and one male) presented with history of fever and jaundice of 2-3 weeks duration. They had marked leukocytosis, hyperbilirubinemia. Ultrasonography revealed large hypoechoic area at the site of caudate lobe compressing portal vein & common bile duct anteriorly and inferior venacava posteriorly. Two patients had evidence of rupture on computed tomography. Patients had received antibiotics and antiamoebic therapy with no resolution of symptoms even after 48-72 hours of therapy. Percutaneous therapy was not possible either because of poor access or the abscess had already ruptured. Laparoscopic drainage was done using three ports and placing wide bore catheters. Post procedure median length of hospital stay was 7 days. Pus culture grew gram negative bacilli in two and third was sterile. None of the abscess revealed Entamoeba histolytica. Primary source of abscesses could not be identified.
Treatment of liver abscess laparoscopically has become popular and carries benefit of minimal invasive surgery which further adds to recovery of severely ill patients. It is now even feasible in deep seated abscesses.