An atypical presentation of intrahepatic perforated cholecystitis: a modern indication to open cholecystectomy. Report of a case.
BACKGROUND
Intrahepatic gallbladder perforation with chronic liver abscess formation was anecdotically reported in the literature. The aim of this work is to report a case of intrahepatic gallbladder perforation and its atypical clinical presentation.


METHODS
A 62-year-old male patient came to our observation; his medical history showed intermittent fever up to 39-40°C of about 2 weeks and anorexia, with an overall weight loss of about 12 Kg. Physical examination of the abdomen was negative. An ultrasound of the liver and an abdominal CT angiogram detected a disomogeneous hypoechoic-hypodense area in the 5th segment of the liver. Differential diagnosis between hepatic abscess or gallbladder cancer remained open. A surgical exploration was planned. After laparoscopic exploration, a conversion to open procedure with an atypical resection of the 5th hepatic segment was performed. Histologic examination of the specimen showed an intrahepatic chronic perforation of the gallbladder with intrahepatic abscess.


CONCLUSIONS
To the best of our knowledge, 18 cases have been reported in the literature as a Niemeier type I perforation. Clinical presentation, even in its extreme rarity, is more often acute. Differential diagnosis between gallbladder cancer versus liver abscess remains controversial. Open approach is mandatory in such cases.
Department of Surgery, General and Oncologic Surgery Unit, Vittorio-Emanuele University Hospital of Catania, via Plebiscito 628, 95122 Catania, Italy. mdonati@unict.it.
Marcello
M
Donati
Antonio
A
Biondi
Francesco
F
Basile
Salvatore
S
Gruttadauria
D002763:Cholecystectomy / Q000379:methods*; D002764:Cholecystitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008100:Liver Abscess / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged