Liver abscess formation is a rare complication of gall bladder perforation with cholecystohepatic communication. We describe a patient who presented with right upper quadrant pain and progressive confusion, and was found to have an intrahepatic perforation of the gall bladder. We discuss the diagnostic work-up and the management of this rare entity. In particular, we look at the increasing role of interventional radiology and the limits of laparoscopic cholecystectomy in the management of such cases. The discrepancies and the modifications in the classification of gall bladder perforation (Niemeier's classification) are also discussed.

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