Background: Hepatolithiasis is the presence of calculi in the intra-hepatic bile ducts. If left untreated, it may cause recurrent cholangitis, hepatic abscesses, cirrhosis, liver atrophy, or degeneration to cholangiocarcinoma. Morbidity increases in bilateral forms of presentation. It is thought that a transitory bactibilia stimulates the formation of lithiasis. This leads to a persistent bactibilia, and therefore increases the risk of cholangitis. The most commonly found micro-organisms in bile cultures are Escherichia coli, Klebsiella, Pseudomonas, and Proteus. Case Presentation: We present the case of a 67-year-old male with a finding of portal hypertension and bilateral hepatolithiasis discovered while studying a dissociated cholestasis. After several unsuccessful attempts for complete extraction of hepatolithiasis through conservative means (transparietohepatic approach, endoscopic retrograde cholangiopancreatography with endoscopic laser therapy) and because of recurrent episodes of cholangitis, a simultaneous surgical and endoscopic approach was undertaken (cholecystectomy with bile duct exploration and intra-operative laser therapy). The patient currently remains asymptomatic. Conclusion: The treatment of hepatolithiasis has evolved because of the increase in the number of non-surgical techniques such as endoscopic laser therapy. Currently a surgical approach implying cholecystectomy and bile duct exploration combined with endoscopic laser techniques could be the elective treatment option, allowing the prevention of hepatectomy especially in patients at elevated surgical risk and in bilateral cases of hepatolithiasis.

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Background: Clostridium septicum is a gram-positive, anaerobic, spore-forming bacilli found in the gastrointestinal tract. It rarely causes spontaneous infections that are associated with high mortality. Association of Clostridium infection with colorectal malignancies or immunosuppression have been reported previously, tumors of the ascending colon are described in most cases. The anaerobic glycolysis of the tumor produces an acidic, hypoxic environment favoring mucosal ulceration and bowel into bloodstream translocation, leading to fulminant sepsis, infected liver metastases, and hollow viscous perforation presenting as pneumoperitoneum. Case Presentation: We report a case of a 61-year-old male with type 2 diabetes mellitus and chronic lymphocytic leukemia who presented with five-day generalized abdominal pain and fever. His symptoms were caused by colon cancer with liver metastases infected with Clostridium septicum. The clinical outcome and management of the case is reported. Conclusion: In patients with hematologic or colorectal cancer and gas-forming liver abscesses, the possibility of Clostridium septicum infection and metastatic cancers should be considered. The aim of this case is to stress the importance of maintaining a high suspicion of Clostridium septicum infection in patients with underlying colonic malignancy.