Gallbladder-duodenal fistula presenting with liver abscess and upper gastrointestinal bleeding.

BACKGROUND: Bilio-enteric communications leading to liver abscess formation are encountered rarely and are therefore not easily suspected by the attending physician. CASE OUTLINE: A bilio-enteric communication involving the gallbladder and the duodenum presented as a septic event with upper gastrointestinal bleeding in a 71-year-old man who was wrongly thought to have undergone a previous cholecystectomy. A pyogenic bacterial liver abscess developed from the fistula in the absence of biliary obstruction. The patient was treated surgically with disconnection of the fistula and drainage of the abscess. DISCUSSION: The liver abscess presumably arose as a consequence of contamination of the bile via the cholecysto-duodenal fistula. The previous operation is likely to have been a simple cholecystostomy.