Korean J Hepatol.  2012 Mar;18(1):94-97. 10.3350/kjhep.2012.18.1.94.

A case of emphysematous hepatitis with spontaneous pneumoperitoneum in a patient with hilar cholangiocarcinoma

• Kim JH
• Jung ES
• Jeong SH
• Kim JS
• Ku YS
• Hahm KB
• Kim JH
• Kim YS

• KMID: 1372657
• DOI: http://doi.org/10.3350/kjhep.2012.18.1.94

Abstract

An 80-year-old woman with hilar cholangiocarcinoma was hospitalized due to sudden-onset abdominal pain. Computed tomography revealed hepatic necrosis accompanied with emphysematous change in the superior segment of the right liver (S7/S8), implying spontaneous rupture, based on the presence of perihepatic free air. Although urgent percutaneous drainage was performed, neither pus nor fluids were drained. These findings suggest emphysematous hepatitis with a hepatic mass. Despite the application of intensive care, the patient's condition deteriorated rapidly, and she died 3 days after admission to hospital. Liver gas has been reported in some clinical diseases (e.g., liver abscess) to be caused by gas-forming organisms; however, emphysematous hepatitis simulating emphysematous pyelonephritis is very rare. The case reported here was of fatal emphysematous hepatitis in a patient with hilar cholangiocarcinoma.

Keyword

Cholangiocarcinoma; Rupture; Hepatitis; Necrosis; Pneumoperitoneum

MeSH Terms

Aged, 80 and over
Anti-Bacterial Agents/therapeutic use
Bile Duct Neoplasms/complications/diagnosis
Bile Ducts, Intrahepatic/pathology
Cefotaxime/therapeutic use
*Cholangiocarcinoma/complications/diagnosis
Clostridium Infections/drug therapy/microbiology
Clostridium perfringens/isolation & purification
Emphysema/complications/*diagnosis
Escherichia coli/isolation & purification
Escherichia coli Infections/drug therapy/microbiology
Female
Hepatitis/complications/*diagnosis
Humans
Metronidazole/therapeutic use
*Pneumoperitoneum/complications/diagnosis
Tomography, X-Ray Computed