2016 Volume 36 Issue 5 Pages 923-926
A 19-year-old man who had sustained injuries after falling accidentally from a height of 7 meters was brought to our critical care center. When he arrived at our center, he was lucid and his respiratory and circulatory statuses were stable. A whole-body CT revealed laceration of the lateral segment of the liver and active vascular contrast extravasation (AAST grade Ⅲ blunt liver injury), with fluid collection in the peritoneal cavity. Transcatheter arterial embolization (TAE) was performed for the hepatic injury, following which hemostasis was achieved. The patient developed high-grade fever on the 3rd hospital day, and a repeat abdominal CT revealed increased free air and a hematoma in the upper part of the abdomen. On the 4th hospital day, the patient’s abdominal pain worsened in severity and physical examination revealed signs of peritoneal irritation potentially suggestive of gastrointestinal perforation. Therefore, emergency laparotomy was performed. Since no damage to the abdominal hollow viscera was found, liver resection and drainage were performed. We speculate that in this case, the free air in the abdomen was found as a result of injury to the intrahepatic bile duct. Non-surgical pneumoperitoneum with biliary peritonitis, as in this case, is difficult to differentiate from perforation of the abdominal hollow viscera.
