Liver-gallbladder anatomical adjacency-related severe infection: a case report of liver abscess rupturing into the gallbladder inducing septic shock and literature review.

BACKGROUND

Gallbladder perforation caused by the anatomical proximity of a liver abscess or indirect inflammatory erosion occurs in less than 3% of reported cases. This case report describes the clinical course of an 84-year-old male patient who developed sepsis secondary to gallbladder perforation caused by a liver abscess. This report, through a representative case, discusses its diagnostic challenges and management strategies to enhance clinical awareness.

CASE DESCRIPTION: The patient presented with a one-day history of right upper quadrant pain and fever. No signs of acute abdominal conditions, such as gastrointestinal perforation, acute pancreatitis, acute cholangitis, or acute appendicitis, were observed on the admission abdominal computed tomography (CT) scan. Within 2 days, the condition progressed with worsening abdominal pain, high fever, and hypotension. An incidental finding on contrast-enhanced ultrasound revealed a liquefied abscess in liver segment V communicating with the gallbladder lumen, confirming the diagnosis of a liver abscess with secondary gallbladder perforation. Blood culture identified Escherichia coli, indicating sepsis progression and diagnostic delay. This course illustrates rapid deterioration from localized infection to systemic life-threatening illness with organ dysfunction. Immediate interventions included ultrasound-guided percutaneous abscess drainage and culture-directed antibiotic optimization, supported by nutritional and symptomatic care. Following treatment, the patient recovered favorably, with imaging showing reduced abscess size, restored gallbladder wall integrity on follow-up ultrasound, and no recurrence on subsequent monitoring.

CONCLUSIONS

This case unveils a rare yet fatal complication of liver abscess perforating into the gallbladder. It serves as a critical reminder for clinicians to include this entity in the differential diagnosis when a liver abscess is adjacent to the gallbladder and systemic infection worsens. Subtle clues on contrast-enhanced CT or ultrasound, such as focal discontinuity of the gallbladder wall, are key to early identification. A staged approach centered on interventional drainage, supported by a multidisciplinary team, is central to the successful treatment of such critically ill patients.