Rare Coincidence of Gallbladder Perforation in Blunt Traumatic Injury: A Case Report

@#Traumatic gallbladder perforation is an unusual but potentially life-threatening injury that can occur following blunt or penetrating abdominal trauma. A 46-year-old male presented to the emergency department following a motor vehicle accident (MVA). He complained of severe abdominal pain and sustained ecchymosis with localized tenderness over the right upper quadrant. Despite a positive focused assessment with sonography in trauma scan, initial computed tomography of the abdomen revealed grade 1 liver and splenic injury but was unable to identify gallbladder perforation. He was initially managed conservatively until he developed secondary signs of sepsis after 24 hours. An exploratory laparotomy revealed a perforated gallbladder. A subtotal cholecystectomy was done. A retrospective review revealed a missed gallbladder perforation from an earlier CT scan assessment. We report a case of missed gallbladder perforation following MVA which was only diagnosed intraoperatively after failing non-operative management, following which the patient underwent laparotomy and subtotal cholecystectomy.

¿Está exenta de consecuencias adversas la perforación iatrogénica de la vesícula biliar durante la colecistectomía laparoscópica electiva? / Iatrogenic gallbladder perforation during elective laparoscopic cholecystectomy, is it exempt from adverse consequences?

Resumen Objetivo: Este estudio se llevó a cabo para valorar las consecuencias de la perforación iatrogénica de la vesícula biliar (PIVB), investigando su asociación con complicaciones posoperatorias, uso de antibióticos y drenajes, duración de la cirugía y estancia posoperatoria. Materiales y Método: Se incluyeron 1.703 pacientes con colecistectomía laparoscópica electiva, divididos en dos grupos: con PIVB (Grupo 1; n = 321) y sin PIVB (Grupo 2; n = 1.382). Se compararon los resultados entre ambos grupos. Resultados: El porcentaje de PIVB fue de 18,85%. El vertido aislado de bilis ocurrió en 241 pacientes (14,15%) y el de bilis y cálculos en 80 pacientes (4,64%). La incidencia de infección del sitio quirúrgico no fue diferente entre ambos grupos. La incidencia de PIVB fue mayor en varones (43,3% vs 31,3%), pacientes con adherencias perivesiculares (17,75% vs. 10,5%) y pacientes con diagnóstico histológico de colecistitis aguda (11,52% vs. 4,92%). La PIVB se asoció significativamente con mayor duración de la cirugía (77,3 vs. 65,4 minutos), mayor uso de drenajes y antibióticos y mayor estancia posoperatoria. No hubo complicaciones tardías. Discusión y Conclusión: La PIVB no aumenta la incidencia de infección, pero se asocia con un mayor uso de drenajes y antibióticos, mayor duración de la cirugía y mayor estancia posoperatoria.

Aim: This study was conducted to evaluate the outcomes in patients with iatrogenic gallbladder perforation (IGP), investigating its association with postoperative complications, use of antibiotics and drains, operative time and postoperative stay. Materials and Method: 1703 patients who underwent elective laparoscopic cholecystectomy were included and divided in two groups: with IGP (Group 1, n = 321) and without IGP (Group 2, n = 1382). We compared the outcomes between both groups. Results: The IGP rate was 18.85%. Isolated bile spillage occurred in 241 patients (14.15%), and stone spillage in 80 patients (4.64%). The incidence of surgical site infections was not different between both groups. The IGP rate was significantly higher in male (43.3% vs 31.3%), in patients with perivesicular adhesions (17.75% vs 10.5%) and in patients with histologic diagnosis of acute cholecystitis (11.52% vs 4.92%). Operative time was significantly longer in patients with IGP (77.3 vs 65.4 minutes). Intraoperative drain and antibiotic use, as well as postoperative stay were, also, significantly higher in patients with IGP. There was not any late complication. Conclusión: Bile and gallstones spillage do not lead to an increase in surgical site infections, but is associated with an increased use of antibiotics and drains, longer operative time and longer postoperative stay.

Gallbladder perforation with concomitant liver abscess: a case report with a review of treatment options

Gallbladder perforation (GBP) management is still controversial in regards to time (early vs. interval), first procedure (surgical vs. drainage) and technique (laparoscopic vs. open). This is the case report of an adult patient with GBP Niemeier type II, complicated with a concomitant hepatic abscess. The patient was treated medically and with laparoscopic drainage of abscess and pyocholecistolithiasis. She was scheduled shortly after for endoscopic retrograde cholangiopancreatography, and posteriorly for definitive treatment with laparoscopic cholecystectomy 1 month later. Satisfactory postsurgical outcome, with uneventful 1-month follow-up.

Colecistitis hemorrágica: reporte de caso y revisión de la literatura / Hemorrhagic cholecystitis: case report and literature review

Resumen Introducción: La colecistitis hemorrágica es una complicación poco frecuente de la colecistitis aguda con una alta mortalidad. Materiales y Método: Paciente con dolor abdominal en hipocondrio derecho e ictericia. Los exámenes de laboratorio y ultrasonido hepatobiliar mostraron datos sugestivos de colecistitis aguda; durante su estancia hospitalaria presenta deterioro de su estado general, realizándose tomografía computarizada mostrando imágenes sugestivas de colecistitis hemorrágica y hemoperitoneo. Resultados: Laparotomía de urgencia, corroborando los hallazgos tomográficos y resolviéndose satisfactoriamente con la colecistectomía. Discusión: El diagnóstico de colecistitis hemorrágica es difícil ya que sus manifestaciones clínicas de inicio no difieren de la colecistitis aguda, por lo que la sospecha clínica y el adecuado estudio de imagen son importantes para su detección. Conclusión: A pesar que la colecistitis hemorrágica con perforación y hemoperitoneo es una patología muy poco común, de diagnóstico confuso, es importante establecer la realización de una tomografía computarizada abdominal con contraste endovenoso en pacientes con sospecha de colecistitis aguda grave.

Introduction: Hemorrhagic cholecystitis is a rare complication of acute cholecystitis with a high mortality. Materials and Method: Patient with abdominal pain in right hypochondrium and jaundice. Laboratory analyses and hepatobiliary ultrasound suggested acute cholecystitis, however, general worsening during hospital stay was observed and a computed tomography was performed, revealing hemorrhagic cholecystitis and hemoperitoneum. Results: Urgent laparotomy which confirmed tomographic results, successfully solved with cholecystectomy. Discussion: Hemorrhagic cholecystitis diagnosis is difficult as symptoms at the beginning do not differ from acute cholecystitis, then, clinical suspicion and a correct image analysis is crucial for its detection. Conclusion: Although, perforated hemorrhagic cholecystitis with hemoperitoneum is a very rare entity with confused diagnosis, an abdominal computed tomography with intravenous contrast is very important in any patient with severe acute cholecystitis suspicion.

Imaging features of computed tomography examination of subacute gallbladder perforation / 中华消化外科杂志

Objective To investigate the imaging features of computed tomography (CT) examination of subacute gallbladder perforation.Methods The retrospective cross-sectional study was conducted.The clinical data of 24 patients with subacute gallbladder perforation who were admitted to the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University between January 2013 and January 2018 were collected.Patients underwent abdominal plain scan and enhanced scan in the arterial phase and portal venous phase of CT,and received percutaneous cholecystostomy,cholecystectomy,choledocholithotomy,T-tube drainage according to their conditions.Observation indicators and evaluation criteria:(1) CT examination situations."Barrier lake sign" is defined as presence of obvious or occult crevasse in the discontinuous gallbladder wall,with interrupt line seen in the portal venous phase and without crevasse enhancement.There is patchy effusion circled by annular wall around crevasse of gallbladder,shape like barrier lake,appearing as oval,semicircle,circular sector,triangle,etc.Annular wall consists of abscess wall,liver margin or both of them.With smooth inner wall of the abscess and irregular outer wall,abscess wall may be complicated with inflammatory exudation and strip shadow,showing intense enhancement in the venous phase.(2) Treatment and follow-up situations.Follow-up using outpatient examination and telephone interview to detect complications after discharge up to January 2018.Measurement data with skewed distribution were represented as M (range).Results (1) CT examination situations.① Completion status and primary diseases:of 24 patients,2 underwent abdominal plain scan,22 underwent abdominal plain scan combined with enhanced scan in the arterial phase and portal venous phase.The primary disease of all the 24 patients was biliary stone,including 18 located in gallbladder cavity,4 located at gallbladder neck and 2 combined with gallbladder stones and common bile duct stones.The maximum diameter was 2.0 cm (range,0.3-2.5 cm)in the 24 patients.② Crevasse of subacute gallbladder perforation:perforations were detected at the bottom of gallbladder in 11 patients,at body of gallbladder in 7 patients (1 with multiple perforations),at gallbladder neck in 1 patient,at bottom and body of gallbladder in 2 patients,and perforation spot was unable to judge in 3 patients.The maximum diameter of occult crevasses was ＜0.2 cm in 2 patients and maximum diameter of crevasses was 0.5 cm (range,0.2-1.0 cm) in other 22 with defined perforation spot.③ Imaging manifestations of "barrier lake sign":24 patients had manifestation of "barrier lake sign".Annular wall consisted of abscess wall,liver margin or both of them was found in 15,3,6 patients respectively.Gallbladder was partially or totally wrapped by abscess in 21 and 3 patients respectively.④ Gallbladder situation:of 24 patients,23 and 1 had gall bladder volume increased significantly and decreased slightly,with a maximum diameter of 10.0 cm (range,6.0-13.0 cm) and thickness of hydropic gallbladder wall as 0.5 cm (range,0.3-1.3 cm).⑤ Other effusion signs:24 patients had increased fat interval density around gallbladder,partly showing cord-like and line-like changes.(2) Treatment and follow-up situations:of 24 patients,10 underwent laparoscopic cholecystectomy,6 underwent open cholecystectomy,4 underwent cholecystectomy + choledocholithotomy + T-tube drainage,1 was converted to open cholecystectomy + choledocholithotomy + T-tube drainage after laparoscopic exploration,3 underwent cholecystectomy at 2 months after percutaneous cholecystostomy combined with anti-inflammatory treatment.Of 24 patients,22 were followed up for 6-31 months with a median time of 11 months.During the follow-up,2 patients were detected residual stones at fossa for gallbladder and end of the common bile duct,2 were detected cholangitis with stones,1 died of tumor,and other 17 survived well without recurrence of calculus or other complications.Conclusion The "barrier lake sign" is a typical feature of CT examination of subacute gallbladder perforation,which provides timely and accurately differential diagnosis and clinical treatment.

Cuerpo extraño intra-abdominal: caso clínico y revisión de literatura / Intra-abdominal foreign body: clinical case and review of the literature

Cases of intra-abdominal foreign bodies are rare and caused mainly by retained elements after surgery and by, in general, accidental swallowing and subsequent perforation of the gastrointestinal tract. We report the case of a 74 year-old female patient, presenting with fever, abdominal pain and weight loss. An abdominal TC showed the presence of a foreign body that had caused a perforation of duodenum and gallbladder neck; surgery showed that it was a 4 cm ‘twist-tie’. The description of the case presents differential diagnoses, based on a review of the literature. This is a rare event and corresponds to the third publication of a case of a twist-tie intra-abdominal foreign body, according to a review of other medical publications.

Los cuerpos extraños intraabdominales son infrecuentes y se deben en gran medida a accidentes quirúrgicos y a ingesta, en general, accidental y posterior perforación del tracto digestivo. Se reporta un caso de una mujer de 74 años con fiebre, dolor abdominal y baja de peso, cuyo estudio mediante tomografía computada de abdomen muestra un cuerpo extraño que perfora duodeno y el bacinete. La cirugía demostró que se trataba de un “twist tie” de 4 cm que perforaba esas estructuras. En la descripción del caso se plantean los diagnósticos diferenciales basados en revisión de la literatura. Se presenta este caso por ser muy infrecuente, correspondiendo a la tercera publicación de un cuerpo extraño intra-abdominal por twist tie, de acuerdo con la revisión de las publicaciones médicas.

Gallbladder perforation: a single center experience of 32 cases

BACKGROUNDS/AIMS: Gallbladder perforation is a rare but potentially fatal disease. We herein present our clinical experience in diagnosis and management of 32 cases of gallbladder perforation. METHODS: This retrospective study was conducted with inclusion of all cases of gallbladder perforation that presented to our hospital from January 2012 to November 2014. Cases of traumatic gallbladder perforation and patients younger than 12 years of age were excluded from this study. RESULTS: This study included 32 patients (13 males and 19 females). The mean age of patients was 55.9 years. Gallbladder perforation was most common in the 5th and 6th decade of life. The mean age of patients with type I, II, and III gallbladder perforation was 57.0 years, 57.6 years, and 49.8 years, respectively. The most common site of perforation was the fundus, followed by the body and Hartmann's pouch (24 : 5 : 2). Most of the type I gallbladder perforations were diagnosed intraoperatively, type II gallbladder perforations were diagnosed by enhanced abdominal computed tomography, and type III gallbladder perforations were diagnosed during laparoscopic cholecystectomy converted to open cholecystectomy for cholelithiasis. Mortality was highest in patients with type I gallbladder perforation. The mean hospital stay was 10.1 days, 6.4 days, and 9.2 days in patients with type I, II, and III gallbladder perforation, respectively. The histopathologic analysis in 28 patients who were operated on showed acute cholecystitis in 19 cases, acute-on-chronic cholecystitis in 4 cases, chronic cholecystitis in 4 cases, and mucinous adenocarcinoma of the gallbladder in a single case. CONCLUSIONS: Gallbladder perforation represents a special diagnostic and surgical challenge. Appropriate classification and management are essential.

¿Hay factores clínicos y/o bioquímicos con los que se pueda presumir diagnóstico preoperatorio de perforación de vesícula biliar? / Are there clinical or biochemical factors that would allow assuming a preoperatory diagnosis of gallbladder perforation?

Objetivo: Conocer la prevalencia e identificar cuáles datos clínicos y/o bioquímicos detectan la perforación vesicular en forma preoperatoria en pacientes con colecistitis aguda. Sede: Hospital General de México, O.D. Diseño: Estudio de casos y controles. Análisis estadístico: Razón de momios, Chi cuadrada (χ²) y t de Student. Material y métodos: Se estudiaron los expedientes de pacientes operados por el servicio de urgencias del Hospital General de México en el periodo de diciembre 2007 a septiembre del 2009. Se revisaron todos los pacientes operados de colecistectomía, seleccionando, de éstos, a los pacientes con reporte de perforación de vesícula biliar (correspondiendo a casos) y se comparó con controles pareados (una perforación por dos no perforados), es decir, pacientes con las mismas características pero sin perforación vesicular. La variables analizadas fueron edad, género, tipo de perforación, signo de Murphy, signos de irritación peritoneal, fiebre, comorbilidades, consumo de tabaco, alcohol o drogas, tiempo de evolución, de ingreso a quirófano, diagnóstico preoperatorio clínico y paraclínico, tipo de abordaje, sitio de perforación, complicaciones y mortalidad. Resultados: Las comparaciones entre cada una de las variables estudiadas y la presencia o no de perforación indica la fiebre (temperatura > 38°C) antes de cirugía como único factor con significancia estadística RM de 1.15 (IC 95% de 0.51 a 2.6) P = 0.001. Conclusiones: La prevalencia de perforación de vesícula biliar en pacientes con colecistitis aguda es de 9.7%. El único dato clínico relacionado a esta complicación y que pudiera hacer sospechar su diagnostico es la fiebre.

Objective: To know the prevalence and to identify which clinical and/or biochemical data can lead to detect gallbladder perforation preoperatively in patients with acute cholecystitis. Setting: General Hospital of Mexico City (Ministry of Health). Design: Study of cases and controls. Statistical analysis: Odds ratio, Chi square (χ²), and Student's t test. Material and methods: We examined the clinical files of patients operated at the Emergency Ward of the General Hospital of Mexico City in the period between December 2007 and September 2009. We reviewed all patients subjected to cholecystectomy, choosing from them those patients with perforation of the gallbladder (cases) and compared them with paired controls (one perforation with two non-perforated), that is, patients of the same characteristics but without gallbladder perforation. Analyzed variables were age, gender, type of perforation, Murphy's sign, sign of peritoneal irritation, fever, comorbidities, alcohol or drug consumption, smoking, time of evolution, time of operating room admittance, clinical and paraclinical preoperative diagnosis, type of approach, perforation site, complications, and mortality. Results: Comparison between each studied variable and the presence or not of perforation reveals fever (temperature > 38°C) as the sole factor with statistical significance, odds ratio of 1.15 (IC 95% from 0.51 to 2.6) P = 0.001. Conclusions: Prevalence of gallbladder perforation in patients with acute cholecystitis is of 9.7%. The only clinical data related to this complication and that could lead to suspect its diagnosis was fever.

A Case of Gallbladder Perforation Complicated by Acalculous Cholecystitis due to Non-Typhoidal Salmonella / 대한내과학회지

Salmonella infections can cause a variety of diseases, but acute acalculous cholecystitis complicated by gallbladder perforation occurs very rarely in adults. Here, we report a case of acute acalculous cholecystitis with gallbladder perforation after non-typhoidal group D Salmonella infection. A 71-year-old man was admitted with fever, chills, and watery diarrhea. Blood cultures taken on admission were positive for non-typhoidal group D Salmonella. The patient subsequently developed acute acalculous cholecystitis, and abdominal ultrasound and computed tomography revealed gallbladder perforation. Because of other medical problems, cholecystectomy could not be performed. The patient's symptoms and signs were not resolved, even after parenteral antibiotic injection and percutaneous cholecystostomy. Despite meticulous supportive care, the patient died after progression to multiple organ dysfunction.

A Case of Acute Cholecystitis with a Perforation Complicating Endoscopic Retrograde Cholangiopancreatography / 대한소화기내시경학회지

The incidence of acute cholecystitis complicating endoscopic retrograde Cholangiopancreatography (ERCP) is rarely reported at 0.2% but is usually associated with a cystic duct obstruction caused by gallstones, gallbladder polyps, or cancer. However, acute cholecystitis with a gallbladder perforation after ERCP without a history of cystic duct obstruction can develop very rarely and has not yet been reported in Korea. We report a case of acute cholecystitis with gallbladder perforation and aggravation of a pancreatic pseudocyst after diagnostic ERCP in a man with a pancreatic cystic lesion. He has been successfully cured using only percutaneous transhepatic gallbladder drainage and antibiotics with no surgery.

Iatrogenic Gallbladder Perforation during Gastric Endoscopic Mucosal Resection

With the exception of accidental perforation during a laparoscopic Cholecystectomy, An Iatrogenic Gallbladder Perforation Is Quite Rare. Several Cases Have Been Reported As A Complication Of Interventional Or Endoscopic Procedures. Although A Case Of Gallbladder And Stomach Perforation During Gastric Endoscopic Mucosal Resection (Emr) Has Been Reported, We Encountered A Case Of Gallbladder Perforation During Gastric Emr Without Evidence Of A Perforation Of The Stomach, Which Has Not Been Reported In The Literature.

Isolated Traumatic Gallbladder Rupture

Gallbladder (GB) injuries after blunt abdominal trauma are uncommon. An isolated blunt GB injury is extremely rare, due to the anatomic location of the GB that is protected by the liver, intestines, omentum and ribs. A GB injury follows a vague and insidious clinical course, and therefore GB injuries are commonly undiagnosed until an exploratory laparotomy is performed. Early diagnosis is important, as trauma to the GB should be treated surgically and a delay in treatment can result in considerable mortality and morbidity. We encountered a patient who was diagnosed with a GB rupture based on computed tomography that showed a hemoperitoneum, high-density material in the GB lumen and a leakage of contrast material. The patient underwent an exploratory laparotomy. We report a case of isolated GB rupture after blunt abdominal trauma.

Gallbladder Perforation without Gallstones or Cholecystitis

A case of gallbladder perforation without cholecystitis or trauma is described herein. The patient was a 74-year-old woman who initially presented with right lower quadrant pain of the abdomen. A laparotomy was performed with the impression of an acute appendicitis at a local clinic. However, the appendix was normal and a large amount of bile was noted in the peritoneal cavity. The patient was referred to our hospital. An exploratory laparotomy was performed with the suspicion of a hollow viscous perforation. A pin point perforation of the gallbladder fundus was identified. There were no gallstones or definite inflammation of the gallbladder wall. Although gallbladder perforation without cholecystitis or trauma is rare, gallbladder perforation without cholecystitis should be considered in elderly patients with bile peritonitis of unknown etiology.

Percutaneous Cholecystostomy and Percutaneous Abscess Drainage in Two Patients of Gallbladder Perforation with High Surgical Risk / 대한소화기내시경학회지

Gallbladder perforation is a grave complication of acute cholecystitis, which has a high incidence of morbidity and mortality in the elderly patients. The unfavorable nature of this disease is due in part to a delay in diagnosis because of the similarity in clinical presentation of patients with uncomplicated cholecystitis and those with perforation. Although prompt surgical intervention with cholecystectomy is the treatment of choice, morbidity and mortality rates rise markedly in the elderly patient with severe systemic illness. In acute cholecystitis, percutaneous cholecystostomy is a good alternative to surgical cholecystectomy or is a temporary measure until a patient is sufficiently stable for surgery. In this report, we describe our experience of successful use of percutaneous cholecystostomy and intra- abdominal percutaneous catheter drainage for the therapy of gallbladder perforation in two patients with high surgical risk.

Unusual Spontaneous Gallbladder Perforation in the Body Portion

Spontaneous gallbladder perforation is a rare complication of acute cholecystitis. The mechanism for the development of this complication is not clear, although a vascular anomaly and ischemia of the gallbladder appear to be important predisposing factors. It is rarely diagnosed preoperatively, and the delay in making the definitive diagnosis usually accounts for the increased incidences of morbidity and mortality associated with this complication. We experienced the unusual case of a 64-year-old male pa tient who presented with a 1-h history of generalized, especially right upper quadrant, abdominal pain. He had no history of traumatic, atherosclerotic, cardiovascular, metabolic disease. Abdominal ultrasono graphy demonstrated generalized free intraperitoneal fluid, especially in right lower quadrant, and was otherwise unremarkable. On palpation, his abdomen was rigid, and a provisional diagnosis of perforated peptic ulcer was made. The patient underwent a cholecystectomy. Gross examination of the gallbladder showed a pinhole perforation (1.2x1.0 mm2) in the body, but no gallstones. Microscopic examination of the wall revealed some neutrophile and lymphocyte infiltration and Widal test was negative. The patient had an uneventful recovery.

Percutaneous Cholecystostomy for Gallbladder Perforation: Early Response and Final Outcome in 10 Patients

PURPOSE: To evaluate the efficacy of percutaneous cholecystostomy (PC) as a therapeutic maneuver for patientswith spontaneous gallbladder (GB) perforation. MATERIAL AND METHODS: Ten patients with acute cholecystitis andsuspected GB perforation underwent emergency PC; perforation was documented by means of ultrasound, computedtomography, and/or fluoroscopy. All patients but two had a variety of high risk factors for open cholecystectomy:diabetes mellitus (n=2), cardiac disease (n=2), acute renal failure (n=1), liver cirrhosis (n=1), overwhelmingsepsis (n=1), and age over 80 (n=1). All percutaneous cholecystostomies were performed with ultrasound guidanceand preferably via the transhepatic route. A favorable response to PC was defined as an improvement in clinicalsymptoms and signs or reduction in fever, and return of the WBC to normal within 72 hr of the procedure. RESULTS:All procedures were technically successful, and no major procedure-related complications occurred. Eight patients(80%) responded favorably to PC. One, who did not respond, underwent emergency cholecystectomy next day due toworsening peritonitis, and the other who failed to respond within 72 hr showed delayed response after drainage ofa coexistent liver abscess at seven days after the procedure. A patient who responded to PC experienced catheterdislodgement four days after the procedure but reinsertion was not required. Five of eight patients who respondedpositively underwent elective cholecystectomy after the improvement of clinical symptoms, and the three remainingpatients improved without further surgery. CONCLUSION: For the treatment of patients in whom GB perforation issuspected, PC is a safe and effective alternative to surgical cholecystectomy.

A Case of Gallbladder Perforation Treated By Percutaneous Transhepatic Cholecystic Drainage and Percutaneous Peritoneal Drainage / 대한소화기내시경학회지

Perforation of gallbladder is a serious complication of acute cholecystitis with alarmingly high mortality rate. These high mortality and morbidity rates were caused by delay in prompt diagnosis and adequate therapy. Especially, mortality and morbidity rates rise markedly in the elderly patient with severe systemic illness. In the patients of gallbladder perforation who are poor candidate for general anesthesia and major operation, percutaneous cholecystic drainage procedure is good alternatives. We experienced a case of gallbladder perforation which was treated successfully by non-operative percutaneous transhepatic cholecystic drainage(PTCCD) in 65-year-old female. She couldn't be a candidate for cholecystectomy or operative chlecystostomy because of severe adhesion of gallbladder to adjacent organ and tissue due to previous gallbladder empyema. We decided to take non-operative percutaneous transhepatic cholecystic drainage and percutaneous peritoneal drainage of abdominal abscess. Thereafter, we examined gallbladder by percutaneous transhepatic cholecystoscopylPTCCS)and rule out gallstone and gallbladder malignancy. So, we presented the case with the brief review of the literatures.