Rare Case of Liver Abscess Secondary to Intrahepatic Rupture of Gallbladder & Cholecystohepatic Fistula Complicating Acute Calculous Cholecystitis in an Uncontrolled Type 2 Diabetic: A Case Report and Review of Literature

Acute calculous cholecystitis rarely progresses to intrahepatic perforation with formation of a giant liver abscess. Such cases are associated with delayed presentation, uncontrolled diabetes mellitus, and significant morbidity. We report the case of a 62-year-old male with poorly controlled diabetes who presented with fever, right hypochondrial pain, vomiting, jaundice, and sepsis. Contrast-enhanced CT revealed acute calculous cholecystitis with intrahepatic rupture of the gallbladder resulting in a large multiloculated hepatic abscess. Initial management consisted of aggressive resuscitation, glycemic optimization, broad-spectrum antibiotics, and ultrasound-guided percutaneous drainage. Persistent postoperative biliary drainage suggested a cholecystohepatic fistula. After optimization of sepsis and metabolic status, laparoscopic cholecystectomy was successfully performed. The patient recovered uneventfully with complete resolution of symptoms. This case highlights the importance of staged management in complicated gallbladder perforation with intrahepatic abscess.