Peer A, Witz E, Manor H, Strauss S
Department of Radiology, Assaf Harofeh Medical Center, Zerifin, Israel.
Abdom Imaging. 1995 Sep-Oct;20(5):452-5. doi: 10.1007/BF01213270.
Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. We report four cases of this condition and describe the imaging procedures related to its diagnosis and treatment.
The medical and x-ray files of 39 patients with percutaneous drainage of liver abscesses were retrospectively reviewed. Four patients with hepatic abscess due to gallbladder perforation were identified. The patients presented with clinical features suggestive of cholecystitis.
Sonography in four patients showed a hypoechoic lesion in the liver adjacent to the gallbladder. CT in three patients showed a hypodense area in the liver, corresponding to the sonographic findings. Percutaneous abscess drainage, followed by an abscessogram, was performed in all patients. Contrast material injected through the drainage catheter filled the gallbladder directly from the abscess cavity. Two patients subsequently underwent cholecystectomy, confirming perforation of the gallbladder fundus. In both cases the gallbladder was noted to be embedded in the liver and covered by adhesions.
Perforation of the gallbladder is a rare cause of pyogenic liver abscess. We suggest, however, based on our two patients who underwent surgery, and several cases reported in the literature, that this condition may be more common when the gallbladder is partially or totally intrahepatic.
胆囊穿孔合并胆囊肝内瘘是肝脓肿的罕见病因。我们报告4例这种情况，并描述与其诊断和治疗相关的影像学检查。
回顾性分析39例行肝脓肿经皮引流患者的病历和X线片。确定4例因胆囊穿孔导致肝脓肿的患者。这些患者表现出提示胆囊炎的临床特征。
4例患者的超声检查显示胆囊旁肝脏有低回声病变。3例患者的CT显示肝脏有低密度区，与超声检查结果相符。所有患者均行脓肿经皮引流，随后进行脓腔造影。通过引流导管注入的造影剂直接从脓肿腔填充到胆囊。2例患者随后接受胆囊切除术，证实为胆囊底部穿孔。在这两例中，均发现胆囊嵌入肝脏并被粘连覆盖。
胆囊穿孔是化脓性肝脓肿的罕见病因。然而，基于我们2例接受手术的患者以及文献报道的几例病例，我们认为当胆囊部分或完全位于肝内时，这种情况可能更常见。
