A geriatric patient with a perirectal abscess, pylephlebitis and multiple pyogenic liver abscesses: a case-report. In this case study, an 86-year-old patient is presented with fever, anorexia and drowsiness, a very high C-reactive protein (CRP) level and elevated liver enzymes. Given the frailty of the patient, a non-invasive diagnostic approach was chosen. Initially, a pancreatic carcinoma with liver metastases was suspected, but the presence of positive blood cultures raised doubts about the initially suggested diagnosis. Ultimately, a perirectal abscess with Streptococcus intermedius bacteremia, pylephlebitis and multiple liver and pancreatic abscesses were diagnosed. After a course of 9 weeks of antibiotics, the patient's condition improved. The vague complaints in this geriatric patient and the lack of invasive diagnostics pose a challenge for the clinician in recognizing this disease.