Low-Energy Trauma: Severe Liver Injury in an Elderly Patient from a Seated Fall

Abstract

BACKGROUND Appropriate management of patients who have fallen is crucial for reducing damage and mortality. We report the case of a patient who fell from a seated position, which caused traumatic liver injury, with gastrointestinal symptoms as the primary patient concern. CASE REPORT A woman in her 80s who was living independently fell from a seated position during the daytime. She presented to our clinic the next day, reporting vomiting and loose stools. Her vital signs included blood pressure of 100/48 mmHg and a pulse rate of 76 beats/minute, with tenderness over the right chest wall. She was suspected of having a fracture in the absence of X-ray imaging and was advised to rest and treated with analgesia on demand. Subsequent laboratory results showed levels of hemoglobin, alanine transaminase, and lactate dehydrogenase of 98 g/L, 659 U/L, and 429 U/L, respectively. At the hospital, a computed tomography scan revealed severe liver injury and rib fractures. Vascular embolization or surgery was not performed, and hematogenous pleural effusion was drained once via thoracentesis. The hematoma did not enlarge, and the patient's ability to perform activities of daily living gradually improved. She was discharged after 10 days of hospitalization. CONCLUSIONS The patient presented with gastrointestinal symptoms, leading to a delayed diagnosis of severe liver injury. Low-energy trauma can cause fatal injuries, and physicians should assess patients who fall for the risk of organ injuries, while being mindful of potential biases. Additionally, non-specific symptoms after trauma can be associated with organ injury.

Figure 1.

Chest X-ray image on the first day of admission (day 3). The image shows air under the skin (arrows).

Figure 2.

Abdominal computed tomography image with enhancement on the first day of admission (day 3). The image shows rupture, with the posterior segment of the right lobe of the liver and a hemorrhagic mass around the rupture (A, arrows), which was determined to be severe hepatic injury. Traumatic hemopneumothorax was identified in the right chest (B, arrows), and right ribs 7–11 were fractured (B, arrowhead).