Pyogenic liver abscess is a rare clinical entity, having a reported incidence of 1.1/100,000 to 3.6/100,000 people in western countries, and with a reported mortality between 5.6-10%, however, this mortality can increase up to 22% if there are multiple abscesses. The prevalence of acute cholecystitis is reported at 0.8-3.8%; Only 2% of all patients with cholelithiasis will present a gallbladder perforation, and the reported mortality in these cases has been reported between 12 to 16%. The most common site of perforation is the gallbladder fundus because it is the most distal portion, which leads to having less blood flow. Its clinical presentation is not specific, and the ultrasound is usually the first imaging tool for diagnosis. Treatment will depend on the clinical condition of each patient. Here we present an 88-year-old female case successfully treated with laparoscopic cholecystectomy and liver abscess drainage despite hemodynamic instabilityPyogenic liver abscess is a rare clinical entity, having a reported incidence of 1.1/100,000 to 3.6/100,000 people in western countries, and with a reported mortality between 5.6-10%, however, this mortality can increase up to 22% if there are multiple abscesses. The prevalence of acute cholecystitis is reported at 0.8-3.8%; Only 2% of all patients with cholelithiasis will present a gallbladder perforation, and the reported mortality in these cases has been reported between 12 to 16%. The most common site of perforation is the gallbladder fundus because it is the most distal portion, which leads to having less blood flow. Its clinical presentation is not specific, and the ultrasound is usually the first imaging tool for diagnosis. Treatment will depend on the clinical condition of each patient. Here we present an 88-year-old female case successfully treated with laparoscopic cholecystectomy and liver abscess drainage despite hemodynamic instability.