{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:05:55Z","timestamp":1787166355686,"version":"build-2736575974"},"reference-count":46,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T00:00:00Z","timestamp":1654732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Acute cholecystitis, which is usually associated with gallstones is one of the most common surgical causes of emergency hospital admission and may be further complicated by mural necrosis, perforation and abscess formation. Perforation of the gallbladder is a relatively uncommon complication of acute cholecystitis (0.8\u20133.2% in recent reviews). The intrahepatic perforation causing a liver abscess is an extremely rare condition, anecdotally reported in the scientific literature, even in the rare types of subacute or acute perforation. Liver abscess caused by gallbladder perforation can be a life-threatening complication with a reported mortality of 5.6%. The treatment of synchronous pyogenic liver abscess and acute cholecystitis may be challenging. We reported three cases of liver abscess due to acute cholecystitis in which different therapeutical approaches were employed. The first case was treated with antibiotics and interval laparoscopic cholecystectomy; the second case was treated with emergency cholecystectomy; and the third case with percutaneous aspiration of the abscess only. The appropriate therapeutical method in these cases depends on the patient\u2019s clinical condition, the on-site expertise that is available in the hospital, and the experience of the surgeon.<\/jats:p>","DOI":"10.3390\/medicina58060782","type":"journal-article","created":{"date-parts":[[2022,6,12]],"date-time":"2022-06-12T22:37:20Z","timestamp":1655073440000},"page":"782","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Pyogenic Liver Abscess Complicating Acute Cholecystitis: Different Management Options"],"prefix":"10.3390","volume":"58","author":[{"given":"Daniel","family":"Paramythiotis","sequence":"first","affiliation":[{"name":"Department of Surgery, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5509-8645","authenticated-orcid":false,"given":"Anestis","family":"Karakatsanis","sequence":"additional","affiliation":[{"name":"Department of Surgery, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7094-0338","authenticated-orcid":false,"given":"Eleni","family":"Karlafti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"},{"name":"Emergency Department, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8849-0416","authenticated-orcid":false,"given":"Stella","family":"Bareka","sequence":"additional","affiliation":[{"name":"Department of Surgery, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Psoma","sequence":"additional","affiliation":[{"name":"Department of Radiology, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3737-9910","authenticated-orcid":false,"given":"Adam A.","family":"Hatzidakis","sequence":"additional","affiliation":[{"name":"Department of Radiology, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios","family":"Michalopoulos","sequence":"additional","affiliation":[{"name":"Department of Surgery, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s00464-011-1856-1","article-title":"Synchronous pyogenic liver abscess and acute cholecystitis: How to recognize it and what to do (emergency cholecystostomy followed by delayed laparoscopic cholecystectomy)","volume":"26","author":"Costi","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/PL00012258","article-title":"Single and Multiple Pyogenic Liver Abscesses: Clinical Course, Etiology, and Results of Treatment","volume":"21","author":"Chou","year":"1997","journal-title":"World J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/MEG.0b013e3282eeb520","article-title":"Intrahepatic perforation of the gall bladder presenting as liver abscess: Case report, review of literature and Niemeier\u2019s classification","volume":"20","author":"Kochar","year":"2008","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1097\/00000658-193499060-00005","article-title":"Acute free perforation of the gall bladder","volume":"99","author":"Niemeier","year":"1934","journal-title":"Annu. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"280","DOI":"10.2484\/rcr.v4i2.280","article-title":"Gallstone Liver Abscess Secondary to Gallbladder Perforation","volume":"4","author":"Izadi","year":"2009","journal-title":"Radiol. Case Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1258\/RSMSMJ.53.1.60H","article-title":"Hepatic abscess secondary to gallbladder perforation: Case report and literature review","volume":"53","author":"Masood","year":"2008","journal-title":"Scott. Med. J."},{"key":"ref_7","first-page":"16","article-title":"Cholecystitis and Synchronous Liver Abscess: Percutaneous Treatment Results","volume":"2","author":"Gabriel","year":"2019","journal-title":"Acta Sci. Gastrointest. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1007\/s00330-001-1247-4","article-title":"Acute cholecystitis in high-risk patients: Percutaneous cholecystostomy vs conservative treatment","volume":"12","author":"Hatzidakis","year":"2002","journal-title":"Eur. Radiol."},{"key":"ref_9","first-page":"e9709242","article-title":"Acute Cholecystitis in Very Elderly Patients: Disease Management, Outcomes, and Risk Factors for Complications","volume":"2019","author":"Cuello","year":"2019","journal-title":"Surg. Res. Pract."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s00423-015-1300-4","article-title":"Laparoscopic cholecystectomy: Consensus conference-based guidelines","volume":"400","author":"Agresta","year":"2015","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/1749-7922-9-58","article-title":"Acute cholecystitis: WSES position statement","volume":"9","author":"Campanile","year":"2014","journal-title":"World J. Emerg. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2892","DOI":"10.1007\/s00464-016-5300-4","article-title":"Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too","volume":"31","author":"Amirthalingam","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/jhbp.517","article-title":"Tokyo Guidelines 2018: Surgical management of acute cholecystitis: Safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)","volume":"25","author":"Wakabayashi","year":"2017","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_14","first-page":"CD005440","article-title":"Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis","volume":"6","author":"Gurusamy","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Serban, D., Socea, B., Balasescu, S., Badiu, C., Tudor, C., Dascalu, A., Vancea, G., Spataru, R., Sabau, A., and Sabau, D. (2021). Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications. Medicina, 57.","DOI":"10.3390\/medicina57030230"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1007\/s00464-012-2565-0","article-title":"Frailty predicts outcome of elective laparoscopic cholecystectomy in geriatric patients","volume":"27","author":"Lasithiotakis","year":"2012","journal-title":"Surg. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s00595-016-1361-1","article-title":"The impact of frailty syndrome and risk scores on emergency cholecystectomy patients","volume":"47","author":"Lorenzon","year":"2016","journal-title":"Surg. Today"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S0039-6109(16)46226-2","article-title":"Organ Physiology of Aging","volume":"74","author":"Evers","year":"1994","journal-title":"Surg. Clin. N. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"374","DOI":"10.14701\/ahbps.2018.22.4.374","article-title":"Clinical outcomes of laparoscopic cholecystectomy in elderly patients after preoperative assessment and optimization of comorbidities","volume":"22","author":"Shin","year":"2018","journal-title":"Ann. Hepato-Biliary-Pancreat. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.advms.2020.08.001","article-title":"Clinical presentation and outcomes of cholecystectomy for acute cholecystitis in patients with diabetes\u2014A matched pair analysis. A pilot study","volume":"65","author":"Spychalski","year":"2020","journal-title":"Adv. Med. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"758","DOI":"10.3892\/etm.2021.10190","article-title":"Clinical and therapeutic features of acute cholecystitis in diabetic patients","volume":"22","author":"Serban","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.amjms.2015.11.011","article-title":"The Effect of Short-Term Hyperglycemia on the Innate Immune System","volume":"351","author":"Jafar","year":"2016","journal-title":"Am. J. Med. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4103\/2230-8210.94253","article-title":"Infections in patients with diabetes mellitus: A review of pathogenesis","volume":"16","author":"Alves","year":"2012","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"486403","DOI":"10.1155\/2014\/486403","article-title":"Stress Hyperglycemia, Insulin Treatment, and Innate Immune Cells","volume":"2014","author":"Xiu","year":"2014","journal-title":"Int. J. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.jviscsurg.2016.11.007","article-title":"The severity grading of acute cholecystitis following the Tokyo Guidelines is the most powerful predictive factor for conversion from laparoscopic cholecystectomy to open cholecystectomy","volume":"154","author":"Bouassida","year":"2017","journal-title":"J. Visc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1007\/s00464-010-1248-y","article-title":"Laparoscopic versus open cholecystectomy in diabetic patients and postoperative outcome","volume":"25","author":"Paajanen","year":"2010","journal-title":"Surg. Endosc."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Spampinato, S.F., Caruso, G.I., De Pasquale, R., Sortino, M.A., and Merlo, S. (2020). The Treatment of Impaired Wound Healing in Diabetes: Looking among Old Drugs. Pharmaceuticals, 13.","DOI":"10.3390\/ph13040060"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"108615","DOI":"10.1016\/j.biopha.2019.108615","article-title":"Mechanistic insight into diabetic wounds: Pathogenesis, molecular targets and treatment strategies to pace wound healing","volume":"112","author":"Patel","year":"2019","journal-title":"Biomed. Pharmacother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.fjs.2015.07.005","article-title":"Impact of diabetes mellitus on cholecystectomy rate: A population-based follow-up study","volume":"48","author":"Liu","year":"2015","journal-title":"Formos. J. Surg."},{"key":"ref_30","first-page":"151","article-title":"Femoral hernia, gangrene of the gall bladder: Extravasation of bile: Peritonitis: Death","volume":"2","author":"Duncan","year":"1844","journal-title":"N. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.jsurg.2008.07.004","article-title":"Type II Gall Bladder Perforation with Abdominal Wall Abscess in a Cirrhotic Patient: Case Report and Review of the Literature","volume":"65","author":"Aljiffry","year":"2008","journal-title":"J. Surg. Educ."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Donati, M., Biondi, A., Basile, F., and Gruttadauria, S. (2014). An atypical presentation of intrahepatic perforated cholecystitis: A modern indication to open cholecystectomy. Report of a case. BMC Surg., 14.","DOI":"10.1186\/1471-2482-14-6"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.amjsurg.2003.08.001","article-title":"Prognostic factors for the development of gangrenous cholecystitis","volume":"186","author":"Fagan","year":"2003","journal-title":"Am. J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s10140-012-1038-z","article-title":"Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: Diagnostic role and spectrum of imaging findings","volume":"19","author":"Tonolini","year":"2012","journal-title":"Emerg. Radiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/j.1532-5415.2011.03759.x","article-title":"An Unusual Case of Cholecystitis and Liver Abscesses in an Older Adult","volume":"60","author":"Soroken","year":"2012","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/1477-7819-8-41","article-title":"Gallbladder perforation associated with carcinoma of the duodenal papilla: A case report","volume":"8","author":"Hosaka","year":"2010","journal-title":"World J. Surg. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"7832","DOI":"10.3748\/wjg.v12.i48.7832","article-title":"Diagnosis and treatment of gallbladder perforation","volume":"12","author":"Derici","year":"2006","journal-title":"World J. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/0002-9610(51)90209-7","article-title":"Perforation of the gallbladder","volume":"81","author":"Fletcher","year":"1951","journal-title":"Am. J. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1016\/j.ajem.2013.04.034","article-title":"Contrast-enhanced ultrasonography to diagnose gallbladder perforation","volume":"31","author":"Tang","year":"2013","journal-title":"Am. J. Emerg. Med."},{"key":"ref_40","first-page":"393","article-title":"Perforations of the gallbladder and cholecystobiliary fistulae: A review of management and a new classification","volume":"79","author":"Anderson","year":"1987","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_41","first-page":"544","article-title":"Liver abscess caused by gallbladder perforation during pyocholecystitis: Apropos of a case","volume":"126","author":"Gilly","year":"1989","journal-title":"J. Chir."},{"key":"ref_42","first-page":"132","article-title":"Laparoscopic Treatment of a Hepatic Subcapsular Abscess Secondary to Gallbladder Per-foration: Case Report","volume":"109","author":"Cristian","year":"2014","journal-title":"Chirurgia"},{"key":"ref_43","first-page":"364","article-title":"Management of Gall Bladder Perforation Evaluation on Ultrasonography: Report of Six Rare Cases with Review of Literature","volume":"4","author":"Singal","year":"2011","journal-title":"J. Med. Life"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/2047-783X-16-5-213","article-title":"Intrahepatic type II gall bladder perforation by a gall stone in a CAPD patient","volume":"16","author":"Kubitz","year":"2011","journal-title":"Eur. J. Med. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"bcr2014204337","DOI":"10.1136\/bcr-2014-204337","article-title":"Successful non-operative management of spontaneous type II gallbladder perforation in a patient with Alzheimer\u2019s disease","volume":"2014","author":"Alessiani","year":"2014","journal-title":"BMJ Case Rep."},{"key":"ref_46","first-page":"195","article-title":"Liver abscess due to acute cholecystitis. Report of five cases","volume":"55","author":"Zerman","year":"2003","journal-title":"Chir. Ital."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/6\/782\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:26:58Z","timestamp":1760138818000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/6\/782"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,9]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["medicina58060782"],"URL":"https:\/\/doi.org\/10.3390\/medicina58060782","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,9]]}}}