Traditional Chinese Acupuncture Causing Acute Hemoperitoneum from Direct Liver Injury

Abstract

Traditional Chinese medicine is a popular form of complementary and/or alternative medicine in Southeast Asia, often incorporating acupuncture. Acupuncture involves the insertion of thin needles into varied anatomical points on the body for the relief of a range of symptoms, such as musculoskeletal aches and pains. We present the first reported case of percutaneous liver injury secondary to acupuncture. We aim to familiarize readers with this rare and as-yet unreported case of intra-abdominal injury related to acupuncture, which is commonly practiced in many countries in Eastern and Southeast Asia.

Keywords: Hepatic injury; acupuncture; complementary and alternative medicine; complications; hemoperitoneum; hepatic hemorrhage; surgery; traditional Chinese medicine.

Figure 1

58-year -old female with acute penetrating hepatic injury secondary to acupuncture. Findings: Axial section on contrast-enhanced, portal venous phase CT scan showing a hyperdense focus (red arrow) adjacent and anterior to the liver surface and falciform ligament; suspicious for active hemorrhage originating from a pinpoint puncture on the liver surface secondary to a penetrating acupuncture needle. Technique: Axial multi-detector CT, portal venous phase (100ml Omnipaque), mA 50–200; kV 120; 5mm slice thickness.

Figure 2

58-year -old female with acute penetrating hepatic injury secondary to acupuncture. Findings: Coronal (Fig 2A) and sagittal (Fig 2B) sections on contrast-enhanced, portal venous phase CT scan showing a hyperdense focus (red arrow) adjacent to the inferior aspect of the liver surface, suspicious for active hemorrhage. Technique: Multi-detector CT, portal venous phase (100ml Omnipaque), mA 50–200; kV 120; 5mm slice thickness.

Figure 3

58-year -old female with acute penetrating hepatic injury secondary to acupuncture. Findings: Axial post-contrast, portal venous image of the abdomen demonstrating linear hyperdense layering of contrast over the left hepatic lobe (green arrow), suggestive of acute hemorrhage originating from the liver. Hyperdense layered fluid overlying the left hepatic lobe; suggestive of hemoperitoneum (red arrow) (Fig 3A). Axial post-contrast image of the pelvis, showing hyperdense layered fluid in the dependent aspects of the pelvis suggestive of hemoperitoneum (red arrow) (Fig 3B). Technique: Multi-detector CT, portal venous phase (100ml Omnipaque), mA 50–200; kV 120; 5mm slice thickness.

Figure 4

58-year -old female with acute penetrating hepatic injury secondary to acupuncture. Findings: Coronal post-contrast, portal venous image of the abdomen demonstrating hyperdense layered fluid overlying the left hepatic lobe; suggestive of hemoperitoneum (red arrow) (Fig 4A). Coronal post-contrast image of the pelvis, showing hyperdense layered fluid in the right lateral aspect of the pelvis suggestive of hemoperitoneum (red arrow) (Fig 4B). Technique: Multi-detector CT, portal venous phase (100ml Omnipaque), mA 50–200; kV 120; 5mm slice thickness.