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A 49-year-old man with a history of HIV presented to an urban level 1 trauma center
as a pedestrian struck by a motor vehicle. In the trauma bay, the patient was hemodynamically stable
(blood pressure 118/82 mm Hg) with sinus tachycardia (heart rate 107 beats/min). He
was breathing comfortably with an SpO2 of 100% on room air, and he was alert and oriented with a Glasgow Coma Score of 15.
The patient was in moderate distress, and complained of severe abdominal pain exacerbated
by movement and transfer. He exhibited rebound tenderness on abdominal exam. His secondary
survey was otherwise negative. Labs demonstrated a leukocytosis of 17.6, and a high
anion gap acidosis (CO2 19, anion gap 16). Focused Assessment with Sonography in Trauma (FAST) exam was negative
for free fluid. Computed tomography (CT) of the abdomen and pelvis shows Couinaud
segment V liver laceration, laceration on the gallbladder, and perihepatic free fluid
(Figure 1). What is the diagnosis?
Figure 1(A) Axial and (B) coronal contrast-enhanced abdominal and pelvic CT performed during
initial trauma evaluation shows laceration of the liver in Couinaud segment V (black
arrow) and rupture of the gallbladder fundus (white arrow). Note the perihepatic free
fluid (white asterisk).
