Results of an abdominal radiograph were normal: no substantial free intra-abdominal gas was observed. Blood tests showed a normal white blood cell count and C-reactive protein level, a slight increase in total bilirubin (1.39 mg/dL) and creatinine (1.27 mg/dL) levels, and a significant increase in aspartate aminotransferase (518 U/L) and alanine aminotransferase (215 U/L) levels (to convert bilirubin level to micromoles per liter, multiply by 17.104; creatinine level to micromoles per liter, multiply by 88.4; and aspartate aminotransferase and alanine aminotransferase levels to microkatals per liter, multiply by 0.0167). An emergently acquired abdominal computed tomographic image showed free retroperitoneal air in the celiac area and devastation at the hepatic hilum; gas surrounded the portal vein and the splenic vein (Figure 1A), spreading along the periportal spaces inside the hepatic parenchyma up to the extremity of the liver (Figure 1B). The gallbladder showed thick walls and was surrounded by a liquid film, with minimal calcified opacity present inside. There was little fluid in the Douglas space, with a small amount around the liver.