A 30-year-old woman with no personal history of interest was admitted to our department with a diagnosis of obstructive jaundice secondary to possible choledocholithiasis. Laboratory tests showed bilirubin of 4.6 mg/dl, GOT 406 UI/l, GPT 512 UI/l, amylase 50 UI/l. Abdominal ultrasound: cholelithiasis. Bile duct not dilated.
ERCP showed a dilated duct without choledocholithiasis and sphincterotomy was performed.
After the test, the patient began with pain in the epigastrium and CDH radiating to the shoulder and a feeling of nausea. On examination, the patient was agitated, hypotensive, tachypnoeic with intense pain in the CDH with significant voluntary defence that made examination difficult. Laboratory tests: bilirubin 1.6 mg/dl, GOT 101 IU/l, GPT 311 IU/l, amylase 71 IU/l, haemoglobin 11.6 g/dl, leucocytes 8,800 µ/l. Abdominopelvic CT scan: collection of 4.7 x 10 x 11 cm with a denser area inside (probably clots and gas bubbles, suggestive of infection) adjacent to the right hepatic lobe. Aerobic in extrahepatic bile duct. No free fluid or pneumoperitoneum.

Based on the poor clinical condition of the patient, who did not respond to any analgesic regimen and the CT findings suggestive of abscess adjacent to the liver with signs of bleeding and infection, and without being able to rule out duodenal perforation, it was decided to perform surgery.
During surgery, a subcapsular haematoma was observed in the right hepatic lobe measuring about 10 cm with bubbles inside. Intraoperative cholangiography was performed in which no alteration in the biliary tract was visualised, as well as cholecystectomy and evacuation of the abscess, leaving a drain in the right subphrenic space.
The patient was taken to the ward and broad-spectrum antibiotic treatment was started.
Liquid culture: E. coli. Sterile blood cultures. Following an episode of anaemia, 4 red blood cell concentrates were transfused. Ultrasound scans and serial scans showed persistent haematoma, so it was decided to place a pig-tail. The evolution was satisfactory and she was discharged after 4 weeks of hospitalisation.