A 64-year-old male, with no relevant personal history, was admitted with progressive diffuse abdominal pain accompanied by malaise, dizziness and profuse sweating.
A few hours before he had been working in the field fumigating with an insect that contained dust for spur.
On admission, the patient showed important diaphoresis with mild sepsis but without neurological focality data.
After hemodynamic stabilization, abdominal CT was performed, which showed areas of varying intensity in the hepatic parenchyma with a large collection of 11 x 6 cm probably related to hemoperitoneum.
The adjacent gallbladder showed a liquid-liquid level without being able to rule out void content.
It also highlighted thickening and enhancement of the gastric antrum and duodenum wall with free perisplenic fluid and in both droplets, so gastroscopy was performed confirming gastroduodenitis without other alterations.
Having established the results, an urgent surgical intervention was decided during which a large hemoperitoneum with suprahepat clots and a gap of about 10 cm in the right hepatic lobe of necrotic aspect with bleeding in the sheet was evidenced.
The bleeding was controlled by hemostatic measures.
The patient was successfully treated postoperatively.
The control abdominal ultrasound showed persistence of the collection although of smaller size that was resolved in its entirety with drainage.
