A retrospective review of 24 patients treated at the University of Chicago for pyogenic liver abscess from 1979 to 1989 was performed to determine if there is a changing etiology in pyogenic liver abscess and if percutaneous drainage is a reliable treatment alternative to open drainage. Biliary tract disease was the most common cause and presented in 29 per cent of patients. Klebsiella and enterococcus were the most common bacterial organisms cultured in 33 and 29 per cent of patients, respectively. The overall mortality rate was 25 per cent, however, if open drainage, in addition to a definitive procedure such as cholecystectomy or bowel resection was performed, there were no deaths. We therefore recommend the use of percutaneous drainage alone only in selected patients.