Acute cholecystitis may result in gallbladder perforation in 6% to 12% of the cases.' According to Niemeier's classification, there are three types of gallbladder perforation: type 1, acute free perforation into the peritoneal cavity; type 2, subacute perforation with pericholecystic abscess; and type 3, chronic perforation with cholecystoenteric fistula.2 Perforation of the gallbladder with pericholecystic abscess is a rare condition, which may present with a specific ultrasonographic picture showing a complex cystic mass in gallbladder fossa.' Moreover, perforation of gallbladder with cholecystohepatic fistula and liver abscess is even rarer. We report a case of this unusual condition and present the ultrasonographic findings.
CASE REPORT
A 60-year-old male patient presented with right upper quadrant abdominal pain for one week before admission. He drank 150 g of alcohol per day for 20 years. The pain was associated with fever, chills, tea-colored urine, and vomiting of bile-stained fluid. No referred pain was described. It was severe for the initial three days, then suddenly improved. On admission, his body temperature was 38" C, pulse rate 80/min, respiration rate 20/min, and blood pressure 130/80 mm Hg. Physical examination revealed sclerae, which were not icteric, and mild tenderness without rebound pain over the right upper quadrant of the abdomen. The liver and spleen were not palpable. The white blood cell count was 14,100/mm3 with 1% bands and 74% segmented. The hemoglobin was 14.1 g/dL and hematocrit