Intrahepatic perforation of the gallbladder causing liver abscesses: case studies and literature review of a rare complication

Abstract

A spontaneous (non-traumatic) gallbladder perforation with gallstone disease is not common. Concomitant development of a liver abscess is a very rare complication observed in such cases. A few cases of intrahepatic gallbladder perforations with chronic liver abscesses have been described. However, a patient series summarising classical and atypical presentations, relevant imaging studies, and the role of surgical and non-surgical options are lacking. We report a short case series on this rare complication of intrahepatic gallbladder perforations and share our experience of management of this condition.

Endoscopic cystic duct stent as primary treatment for intrahepatic gallbladder perforation with abscess formation

“…Gallbladder perforation with intrahepatic abscess formation is an extremely rare condition, with only around ten cases documented in the world literature. 1 For perforation to occur, the cystic duct must become occluded. In the context of cholecystitis this is usually due to calculi.…”

“…However, both teams commented on the technical difficulty involved in such an operation owing to the presence of adhesions, with one team opting for subtotal cholecystectomy to reduce the risk of bile duct injury. 1,2 ERCP is routinely used for the retrieval of stones from the common bile duct and stent placement in malignant and benign lesions of the biliary tree. Placement of a stent into the cystic duct for benign disease is not routinely attempted, as it is technically challenging with a risk of perforation, especially in the presence of impacted stones or cholecystitis.…”

“…Perforation of the gallbladder is a rare presentation of gallstone disease, with recent literature showing an incidence of 3.2%. 1,2 Niemeier classified gallbladder perforations into three types: type I: acute perforation into the abdomen, with biliary peritonitis type II: sub-acute pericholecystic abscess development type III: a consequence of chronic cholecystitis with formation of a bilioenteric fistula. 1,2 The most recognised sequelae are an acute abdomen with free fluid in the peritoneal cavity or fistulation into a hollow viscus.…”

“…1,2 Niemeier classified gallbladder perforations into three types: type I: acute perforation into the abdomen, with biliary peritonitis type II: sub-acute pericholecystic abscess development type III: a consequence of chronic cholecystitis with formation of a bilioenteric fistula. 1,2 The most recognised sequelae are an acute abdomen with free fluid in the peritoneal cavity or fistulation into a hollow viscus. 1,2 The formation of an intrahepatic abscess is rare, with only anecdotal cases in the world literature, but it carries a significant mortality of 5.6%.…”

“…1,2 The most recognised sequelae are an acute abdomen with free fluid in the peritoneal cavity or fistulation into a hollow viscus. 1,2 The formation of an intrahepatic abscess is rare, with only anecdotal cases in the world literature, but it carries a significant mortality of 5.6%. 2 We report a case of intrahepatic abscess formation as a consequence of gallbladder perforation and a novel approach to the management of this condition.…”