Liver laceration from laparoscopic port insertion

Interval cholecystectomy. Gas and fluid-filled collection are present at the cholecystectomy bed consistent with postoperative status. Dilatation of the intra and extrahepatic bile ducts is unchanged from preoperative imaging. No calculus identified.

There is a heterogeneous subcapsular hypodensity through segment 3 of the liver. This underlies the region of the midline epigastric laparoscopy port site, and is suggestive of laceration from port insertion. There is overlying capsular bulging indicative of small subcapsular hematoma. Heterogeneous density through the region of laceration is nonspecific on this single phase study and extends down towards the branches of the left portal vein. A multiphase study of the liver is recommended to exclude active bleeding and vascular complications of laceration.

There are 2 small, indeterminate hypodense liver lesions in subcapsular segment 6 of the liver.

Kidneys, spleen and adrenal glands are unremarkable. Fatty replacement throughout the pancreas.

No dilated bowel loops. No focal osseous lesions.

There is an diffuse calcification of the tracheobronchial tree. Multifocal mucus plugging with collapse of the right lower lobe and small right pleural effusion. Left basal atelectasis.

Impression

• segment 3 hepatic laceration subjacent the epigastric port site and extends down the branches of the left portal vein. No active hemorrhage as demonstrated on single phase study, however given the proximity to the hepatic vessels and heterogeneous appearance through the laceration, evaluation with a dedicated multiphase CT of the liver is recommended to exclude vascular complication

• indeterminate hypodense lesions segment VI of the liver could also be further evaluated at time of multi phase CT

• complete collapse of the right lower lobe with multifocal bronchial plugging, suspicious for aspiration