AN OPERATED CASE OF INTRAABDOMINAL BLEEDING OCCURRED 8 HOURS AFTER A PIECE OF IRON STUCK INTO THE LIVER

A 58-year-old man visited another hospital at about 2 p.m. on August 31, 1996, because a piece of iron nail perforated his abdominal wall when he was driving in the nail by a hammer and then an abdominal pain gradually appeared. Simple abdominal X-ray film revealed a piece of iron in the abdomen, and so he was referred to the hospital. Abdomincal CT scan revealed the immigrated iron piece in the S3 of the liver, but no intraabdominal bleeding was noted. A mild abdominal pain still lasted but the general condition was stable. As elective surgery for removal of the foreign body was scheduled for the patient. About 8 hours later, however, severe abdominal pain as well as hypotension occurred and the patient fell into a shock state. Abdominal ultrasonography revealed a pool of liquid under the left diaphragm. With a diagnosis of intraabdominal bleeding due to hepatic injury, an emergency operation was conducted. Upon median incision of the upper abdomen, there were about 1300ml of bloody ascites and a ruptured injury about 6mm in length on the surface of the S3 of the liver that might be made by stabbed iron piece, and the ruptured was bleeding site. After the iron piece was removed, the ruptured wound was sutured. Postoperative course was uneventful and the patient was dischaged from the hospital on the 17th hospital day.