Abstract
We present, a 69 years old gentleman, known case of cholelithiasis, who presented in septic shock, with history of severe right upper quadrant abdominal pain since 3 days. CT scan of his abdomen showed intrahepatic rupture of gall bladder with peripherally enhancing lesion in liver communicating with the gall bladder lumen suggestive of empyema gall bladder. Few gall stones appeared to have migrated into the liver parenchyma. He underwent ultrasound guided percutaneous cholecystotomy with a plan for elective cholecystectomy at a later date.