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Il Giornale Italiano di Radiologia Medica 2019 Gennaio-Febbraio;6(1):45-9

DOI: 10.23736/S2283-8376.19.00153-0


language: English, Italian

A rare case of intrahepatic abscess secondary to spontaneous gallbladder perforation in a cancer patient treated by interventional radiology procedure

Piero TROVATO 1, Igino SIMONETTI 1 , Francesco VERDE 1, Stefano G. PICCHI 1, Mattia SILVESTRE 1, Fabio CORVINO 1, Piero VENETUCCI 1, Maria G. CAPRIO 2, 3

1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; 2 Section of Pediatric Diagnostics, Department of Radiology, University Hospital Federico II, Naples, Italy; 3 Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy


The development of an intrahepatic abscess is a rare complication of spontaneous gallbladder perforation, with a mortality of 12-16%. The prevalence of this condition is higher in patients with acute cholecystitis than those with chronic cholecystitis. The symptomatology is generally no-specific and can be associated with an increase of liver enzymes and inflammatory indices. In 1934 Niemeier classified the gallbladder perforations in three types: 1) acute perforation into the free peritoneal cavity; 2) subacute perforation with abscess formation; 3) chronic perforation with fistula formation between the gallbladder and another viscus. Diagnosis and management of intrahepatic gallbladder abscess is based on the integrated use of radiological diagnostic tools, such as ultrasound (US) and computed tomography (CT), and of radiological intervention procedures, such as the ultrasound guided percutaneous of the abscess formation, which represents a diagnostic and therapeutic procedure. We report a rare case of a 71-year-old male with liver cirrhosis and history of colon cancer treated with surgery and adjuvant chemotherapy, came to our observation for an abdominal ultrasound for occurrence of dyspeptic symptoms, latent jaundice and increase of cholestasis levels and inflammatory indices, which revealed a picture of cholecystitis and a hypoechoic formation in the VII-VIII liver segment. In the suspicion of secondary localization, a CT scan was performed that showed an abscess formation in communication with the gallbladder through a fistula. The next echo-guided percutaneous drainage of the collection allowed to confirm the nature of the abscess and allowing a mini-invasive treatment.

KEY WORDS: Ultrasonography - Spontaneous perforation - Cholelithiasis - Radiology, interventional

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