Hepatogastric Fistula as a Rare Complication of Pyogenic Liver Abscess: A Case Report

Hepatogastric fistula is a rare complication of pyogenic liver abscess. We report an 18-year-old male with 3 weeks of fever, melena, and epigastric discomfort. Ultrasound showed a contracted gallbladder with wall thickening and sludge without cholelithiasis. Triphasic CT demonstrated a solid-cystic collection in hepatic segments IV and V abutting the gastric antrum, compatible with a fine communication. Esophagogastroduodenoscopy revealed a 3 mm antral mucosal orifice with purulent drainage. Smear showed neutrophil-predominant exudate and Gram-positive cocci; culture yielded Staphylococcus aureus susceptible to ciprofloxacin and clindamycin. Therapy was narrowed to ciprofloxacin 400 mg twice daily and clindamycin 600 mg three times daily. A 14-day Helicobacter pylori eradication regimen was completed. Subsequently, laparoscopic cholecystectomy was performed. Intraoperatively the gallbladder was contracted with an inflamed but intact wall containing sludge; Calot's triangle was edematous yet the critical view of safety was obtained, and no cholecystoenteric fistula was identified. No drainable hepatic collection was present, consistent with decompression through the antral orifice. Opening the specimen demonstrated microlithiasis. Recovery was uneventful, and the patient remained with normal laboratory indices at 3 months. This case highlights the complementary roles of cross-sectional imaging and endoscopy and supports individualized management in young patients with biliary-source liver abscess.