A case of perforation of gallbladder coexisting with right subphrenic abscess successfully treated by elective laparoscopic cholecystectomy

Abstract

The case was a 82-years-old man, who had been receiving outpatient treatment at the local hospital because of abdominal pain. He was pointed out liver dysfunction and high elevation of inflammatory reaction and referred to our hospital. At the initial visit, high elevation of inflammatory reaction and slight elevation of hepatobiliary enzymes in the serum were seen. Abdominal plain CT revealed swelling of the gallbladder and a right subphrenic abscess with right pleural effusion. On the same day, percutaneous drainage for the right subphrenic abscess was performed and administration of antibiotics was started. Abdominal MDCT with the abscess cavity filled with contrast medium on the 12^th day after the drainage revealed a fistula from the abscess cavity to the gallbladder and he was diagnosed as having a right subphrenic abscess due to perforation of the gallbladder. After improvement of inflammation, laparoscopic cholecystectomy was performed on the 19^th day after admission. The postoperative course was uneventful, therefore, the drain was removed on the 13^th day. He was discharged on the 17^th day after the operation. Although the therapeutic management for the perforation of the gallbladder with a subphrenic abscess is not established because of its rarity, an elective laparoscopic cholecystectomy after percutaneous subphrenic abscess drainage was possible with less invasion.