Endoscopic Drainage of an Intrahepatic Abscess Secondary to a Perforated Gallbladde

A 68-year-old woman presented with abdominal pain, nausea, vomiting, and altered mental status. Subsequent imaging demonstrated a well-circumscribed nonenhancing fluid collection within the hepatic parenchyma adjacent to the gallbladder. Management was discussed in a multidisciplinary manner, and a decision was made to pursue endoscopic management with a single anesthetic. Endoscopic retrograde cholangiopancreatography with biliary sphincterotomy and clearance of the bile duct, endoscopic ultrasound puncture of the gallbladder from the duodenum and placement of a lumen-apposing stent (ie, creation of a cholecystoduodenostomy), and placement of a double pigtail into the hepatic abscess were performed. The procedure was successful without any intraoperative or postoperative complications. Follow-up imaging demonstrated near-resolution of the abscess. Repeat endoscopy was performed to remove the remaining stones from the gallbladder. At follow-up, the patient remained well and was symptom-free.