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A 70-year-old woman presented with right upper quadrant pain and fever since 1 month, with exacerbation of symptoms since 1 week. Clinically, she had tenderness in the right hypochondrium; laboratory parameters showed elevated AST, ALT and alkaline phosphatase values. Ultrasonogram abdomen showed a large abscess in liver with suspicious communication with gallbladder. CT scan of abdomen showed a large irregular thick-walled cystic lesion in segments 5 and 8 of liver suggestive of a liver abscess. This cavity communicated with a thick-walled edematous gallbladder, that contained few calculi (Fig. 1). A diagnosis of empyema gallbladder with intrahepatic rupture and abscess formation in the liver was made. Ultrasound-guided percutaneous drainage of the abscess was done with a plan for elective laparoscopic cholecystectomy.
Perforation of the gallbladder is a rare complication that occurs in 2 % to 11 % of acute cholecystitis; delay in diagnoses is a major cause of morbidity and mortality [1]. Niemeier classified gallbladder perforations into 3 types: type I—acute, manifests with generalized peritonitis; type II—subacute, which denotes localization of fluid at the site of perforation with formation of a pericholecystic abscess; and type III—chronic, in which internal or external fistula occur [2]. Our patient had Type II perforation.
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Kamalesh, N.P., Pramil, K. & Prakash, K. Intrahepatic rupture of empyema gallbladder. Indian J Gastroenterol 31, 280 (2012). https://doi.org/10.1007/s12664-012-0230-0
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DOI: https://doi.org/10.1007/s12664-012-0230-0