Liver abscess as a complication of intrahepatic gallbladder perforation in a septuagenarian: a case report and literature review

Abstract

Acute cholecystitis is a common complication of gallstone disease; however, gallbladder perforation with intrahepatic abscess formation is a rare and potentially life-threatening entity. We report the case of a 67-year-old man with long-standing type 2 diabetes mellitus, end-stage renal disease on peritoneal dialysis, and hypertension who presented with nonspecific constitutional symptoms and minimal abdominal findings. Laboratory evaluation revealed leukocytosis and abnormal liver function tests. Computed tomography demonstrated acute cholecystitis with intraluminal gas and adjacent hypodense lesions in hepatic segments VII and VIII, concerning for pyogenic liver abscesses secondary to gallbladder perforation. Exploratory laparotomy confirmed complicated acute cholecystitis with dual gallbladder perforation, including posterior extension into the hepatic parenchyma with intrahepatic abscess formation. Due to severe inflammation and unsafe biliary dissection, subtotal fenestrating cholecystectomy was performed as a bailout procedure with abscess drainage. Histopathology confirmed acute ulcerated cholecystitis with mucosal necrosis and intramural gallstones. The postoperative course was uneventful. This case highlights the diagnostic challenge of intrahepatic gallbladder perforation in high-risk patients and supports early cross-sectional imaging and operative source control when severe inflammation precludes safe definitive dissection.