Case presentation A 70-year-old woman was presented to an emergency department with sharp abdominal pain in the left lower quadrant. She had been experiencing the pain for the past seven hours with one episode of vomiting. Her temperature was normal. History Hypertension Type II diabetes mellitus treated with oral therapy Investigation Physical examination A physical examination revealed tenderness to deep palpation with mild resistance.
Her bowel sounds were barely audible. Laboratory workup The results of the laboratory investigations are given below – Total bilirubin: 1.39 mg/dL Creatinine: 1.27 mg/dL Aspartate aminotransferase: 518 U/L Alanine aminotransferase: 215 U/L Radiological workup An abdominal computed tomography revealed the following – Free retroperitoneal air in the celiac area Devastation at the hepatic hilum. The presence of gas surrounding the portal and splenic…
