Feasibility of laparoscopic surgery in the management of rare intrahepatic perforation of the gall bladder and liver abscess

Vishwas Johri,Vimal Kumar Dhaduk,Prasanna Kumar Reddy,Nikunj Jain

doi:10.4038/sljs.v37i3.8566

Abstract

Feasibility of laparoscopic surgery in the management of rare intrahepatic perforation of the gall bladder and liver abscess

Highlights

Gall bladder perforation is an uncommon complication of acute cholecystitis in present time due to increased number of cholecystectomies being offered at an early disease stage and laparoscopic cholecystectomy being a straight forward and established gold standard procedure
Case presentation 1 A 45 year old gentleman presented with intermittent episodes of upper abdominal pain over 4 years which increased in severity in the last 2 weeks
It may be attributed to increased availability and simplicity of laparoscopic cholecystectomy and due to availability of better antimicrobial and analgesic agents

Summary

Introduction

Gall bladder perforation is an uncommon complication of acute cholecystitis in present time due to increased number of cholecystectomies being offered at an early disease stage and laparoscopic cholecystectomy being a straight forward and established gold standard procedure. Case presentation 1 A 45 year old gentleman presented with intermittent episodes of upper abdominal pain over 4 years which increased in severity in the last 2 weeks A CECT abdomen showed features of chronic cholelithiasis with intra hepatic extension of gall bladder with breech in posterior wall [Fig.1a] and abscess formation in segment 5 and 6 of liver[Fig. 1b]. The Sri Lanka Journal of Surgery 2019; 37(3): 22- 24 underwent therapeutic ERCP and CBD stenting and was advised to report back for definitive surgery after 8 weeks Six weeks later he presented to the emergency department with abdominal pain fever with chills. The CECT abdomen showed calculous cholecystitis with gall bladder fundus attached to the under surface of liver and colon and an abscess in segment 5 of the liver [Fig.2a].

Discussion

Conclusion