title: A case of emphysematous hepatitis with spontaneous pneumoperitoneum in a patient with hilar cholangiocarcinoma.
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.
authors.affiliation: Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea.
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Kim
authors.forename: Eul Sik
authors.initials: ES
authors.lastname: Jung
authors.forename: Seok Hoo
authors.initials: SH
authors.lastname: Jeong
authors.forename: Ju Seung
authors.initials: JS
authors.lastname: Kim
authors.forename: Yang Suh
authors.initials: YS
authors.lastname: Ku
authors.forename: Ki Baik
authors.initials: KB
authors.lastname: Hahm
authors.forename: Ju Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Yeon Suk
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D002439:Cefotaxime / Q000627:therapeutic use; D018281:Cholangiocarcinoma / Q000150:complications / Q000175:diagnosis; D003015:Clostridium Infections / Q000188:drug therapy / Q000382:microbiology; D003016:Clostridium perfringens / Q000302:isolation & purification; D004646:Emphysema / Q000150:complications / Q000175:diagnosis*; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006505:Hepatitis / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D011027:Pneumoperitoneum / Q000150:complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002439:Cefotaxime