Background
Perforation of the gallbladder has become a relatively uncommon complication of the natural history of cholelithiasis during acute cholecystitis (0.8–3.2% in recent reviews). It usually bursts with an acute abdomen and must be operated as a surgical emergency before causing septic peritonitis. Gallbladder perforations were classified following Niemeir's proposal of 1934. Gallbladder can perforate freely in the abdominal cavity or in a neighboring organ causing many different clinical situations. The intrahepatic perforation causing a liver abscess is an extremely rare condition, anedoctically reported in the world literature, even in the rare type II or III perforation (subacute or acute perforation). Liver abscess caused by gallbladder perforation can be a a life-threatening complication (5.6% mortality). Current management of intrahepatic or hepatic abscess is to submit the patient to a percutaneous drainage supported by intravenous antibiotic therapy, when abscess size does not exceed 5 cm, otherwise surgical exploration and drainage remains the first line treatment option for pyogenic liver abscess. In cases of gallbladder perforation cholecystectomy is, of course, the treatment of choice, even if in these cases the laparoscopic approach can be problematic. The aim of this work is to report on an intrahepatic type I perforation of the gallbladder leading to a chronic hepatic abscess, causing a very rare and atypical clinical picture.