Intra-Hepatic Perforation of Gall Bladder Causing Liver Abscess Mimicking Malignancy: A Rare Presentation

Introduction-Spontaneous gall bladder perforation (GBP) in cases of gall stone disease is rare with an incidence of 0.8-3.2% and with its wide range of sequelae, carries a high morbidity as well as mortality. Intra-hepatic GBP creating a cholecystohepatic fistula are perhaps a bit research with just about a dozen cases reported worldwide, needs to be brought forward for their challenging pre-operative diagnosis. Case outline-We report a case of a 57 years old adult male who came with complaints of right hypochondrial pain and fever since 2-3 months. Ultrasound and Triple phase CT were suspicious of concomitant cholelithiasis and gall bladder malignancy with liver infiltration. A pre-operative FNAC from the liver lesion was suggestive of chronic inflammatory cells and pus thus clenching the diagnosis. The patient was managed with repeated aspirations of the liver abscess and a definitive Laparoscopic cholecystectomy with lavage of the abscess cavity. Conclusion-In cases of GBP, possibility of Intra-hepatic GBP and Cholecystohepatic fistula should be kept in mind. Pre-operative radiology and histopathology can help distinguish between liver abscess and malignancy. With more cases being reported and advanced imaging techniques, there is better understanding of the complex anatomy relating a cholecystohepatic fistula leading to a reduction in the number of conversions of laparoscopic cholecystectomy to open cholecystectomy.