This journal only 2016, Number 1 Rev Mex Cir Endoscop 2016; 17 (1) Rupture of intrahepatic gallbladder by gallbladder empyema appearing as liver abscess: a case report Bolívar RMA, Cázarez AMA, Guadrón LCO, Fierro LR, Basil DGA, Valdespino GB Full text How to cite this article Language: Spanish References: 5 Page: 43-46 PDF size: 242.06 Kb. Key words: Gallbladder empyema, gallbladder perforation, Niemeier classification, hepatic abscess. ABSTRACT Introduction: The gallbladder empyema is a complication of acute cholecystitis that may occur from 2 to 15% of patients. A rare presentation of this entity is intrahepatic gallbladder perforation presenting as a liver abscess (Niemeier type 2) undrained to abdominal cavity, finding only 19 cases reported on literature. Material and methods: 51 years old male with history of diverticular disease, starts with moderate abdominal colicky pain five days of evolution, epigastric predominance, accompanied by nausea and vomiting on countless occasions, unquantified fever, abdominal distension, pain intensity increases and comes to medical evaluation. Physical examination shows abdominal distension, present hypoactive peristalsis, widespread tympanic percussion, voluntary muscle stiffness, painful on palpation of the entire abdomen, positive Murphy’s sign and rebound, with tachycardia 130 bpm, tachypnea with 28 rpm, hypotension of 90/55, abdominal computed tomography is performed with gallbladder empyema report and hypodense image parenchyma likely abscess liver so decides admission to intensive care to start with sepsis protocol with early goal directed therapy to perform a laparoscopic cholecystectomy. Results: We found a gallbladder empyema, an intrahepatic rupture of the gallbladder with a hepatic abscess by contiguity (Niemeier type 2), Cholecystectomy was performed, afterwards the opening of the hepatic abscess cavity, conclude with drainage and irrigation of the abscess cavity, with favorable evolution and the discharge of the patient 4 days after the admission without complications. Conclusion: Intrahepatic gallbladder perforation with formation of liver abscess should be considered as an exceptional clinical entity and regardless of imaging, continues to be a clinical challenge to diagnose. In our opinion the complete laparoscopic approach of this pathology is safe, fast and with great outcome. REFERENCES Göbel T, Kubitz R, Blondin D, Häussinger D. Intrahepatic type II gallbladder perforation by a gallstone: in a CAPD patient. Eur J Med Res. 2011; 16: 213-216. Lo HC, Wang YC, Su LT, Hsieh CH. Can early laparoscopic cholecystectomy be the optimal management of cholecystitis with gallbladder perforation? A single institute experience of 74 cases. Surg Endosc. 2012; 26(11): 3301-3306. Niemeier OW. Acute free perforation of the Gall-Bladder. Ann Surg. 1934; 99: 922-924. Date RS, Thrumurthy SG, Whiteside S, Umer MA, Pursnani KG, Ward JB. Gallbladder perforation: case series and systematic review. Int J Surg. 2012; 10: 63-68. Kochar K, Vallance K, Mathew G, Jadhav V. Intrahepatic perforation of the gall bladder presenting as liver abscess: case report, review of literature and Niemeier’s classification. Eur J Gastroenterol Hepatol. 2008; 20: 240-244.