C 2 - INTRA-HEPATIC GALLBLADDER PERFORATION CAUSING CHOLECYSTO-HEPATIC FISTULA MANAGED WITH ROBOTIC-ASSISTED SURGERY

Objectives: Acute and chronic cholecystitis can lead to the uncommon complication of gallbladder perforations with rupture of biliary content into the peritoneal cavity or the rarer complication of intrahepatic perforations with hepatic abscess formation. There is a limited number of cases of intrahepatic gallbladder perforations with liver abscess formation described, and therefore, there is no standardized management of this condition. The prevalence of mortality associated with this complication is high, even after aggressive management, making it a diagnostic and surgical challenge. Many of these patients are sick with multiple comorbidities, so they are often managed non-surgically with cholecystostomy tube placement, percutaneous drainage of the liver abscess, and broad-spectrum antibiotic coverage. The intrahepatic nature of the gallbladder perforation can lead to difficulties in laparoscopic cholecystectomy, with a high prevalence of conversion to open cholecystectomy. Due to the limited number of cases, each one is relatively informative. There is no video presentation of this minimally-invasive robotic-assisted approach to treat this rare complication, and we present you with such a case.

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