Successful treatment of laparoscopic surgery in treating acute diffuse peritonitis due to drug-induced acute liver injury: a case description

Sep 30, 2026

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Case description of acute diffuse peritonitis secondary to drug-induced acute liver injury focuses on a clinical presentation after self-administration of multiple analgesic and other medications. A 27-year-old male developed fever and upper abdominal distension followed by intermittent worsening, with laboratory abnormalities indicating both infection and hepatic injury while viral hepatitis markers stayed normal. Intraoperative findings and liver biopsy pathology supported drug-induced liver injury, and the patient received laparoscopic abdominal drainage with subsequent reassessment of infection and liver function trends across time points.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Case presentation

Laboratory findings and clinical assessment

Treatments and re-evaluation

Letter to the Editor Successful treatment of laparoscopic surgery in treating acute diffuse peritonitis due to drug-induced acute liver injury: a case description Mei Xie1^, Gen-Fei Zhu2^ 1Department of Radiology, Zhejiang Hospital, Hangzhou, China; 2Department of General Surgery, Zhejiang Hospital, Hangzhou, China Correspondence to: Gen-Fei Zhu, MD. Department of General Surgery, Zhejiang Hospital, No. 12, Lingyin Road, Hangzhou 310006, China. [Email: nju2005@126.com](Email: nju2005@126.com). Submitted Mar 05, 2025. Accepted for publication Oct 23, 2025. Published online Dec 31, 2025. doi: 10.21037/qims-2025-554 View this article at: [https://dx.doi.org/10.21037/qims-2025-554](https://dx.doi.org/10.21037/qims-2025-554) Introduction Acute liver failure (ALF) is primarily attributed to druginduced liver injury (DILI), exhibiting an incidence rate ranging from 14 to 19 cases per 100,000 individuals (1) . The list of clinical medications linked to DILI is perpetually expanding, with the incidence of DILI exhibiting an annual uptrend (2) . Since the diagnosis of DILI hingeson the exclusion of other potential causes, progress in both prevention and treatment has remained limited (1) . Emergency laparotomy is frequently performed in instances of acute diffuse peritonitis, owing to its potentially lifethreatening characteristics (3) . Laparoscopy offers significant advantages due to its extensive applicability in both diagnosing and managing acute abdominal conditions (4,5) . Nevertheless, there is no published research on the application of laparoscopic surgery for treating acute DILI complicated by diffuse peritonitis. In the case detailed herein, the patient was effectively treated via laparoscopic abdominal drainage following a diagnosis of acute diffuse peritonitis. The intraoperative images and liver biopsy pathology confirmed the presence of DILI. Case presentation A 27-year-old male, with no prior history of liver or kidney disorders, alcohol intake, food and medication allergies, or coronavirus disease 2019 (COVID-19) infection within the past 28 days, was admitted to the gastroenterology department. He presented with fever and upper abdominal distension for 2 days following the consumption of hot pot. He experienced chills, fever, dizziness, and fatigue, without having measured his body temperature. Subsequently, he experienced intermittent episodes of abdominal distension and discomfort in the upper abdomen, accompanied by nausea. There were no visible signs of vomiting or diarrhea. He self-administered three bags of GanMaoLingKeLi [999] [total 1.2 g N-acetyl-para-aminophenol (APAP); 999 Pharmaceutical, Shenzhen, China], along with six tablets of New Contech (total 3 g APAP; Shanghai Johnson & Johnson Pharmaceutical, Shanghai, China) over 12 hours. Additionally, he took three ibuprofen extended-release capsules (total 0.9 g ibuprofen; Pfizer, New York, NY, USA) within 24 hours. Although his fever subsided and the abdominal pain significantly alleviated after the medication was administered, he later experienced a resurgence offever, chills, and intermittent upper abdominal discomfort the following day. Laboratory analyses uncovered abnormal indicators of both infection and liver damage ( Table 1), whereas markers for viral hepatitis were observed to remain within normal limits. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s), and with the Helsinki Declaration and its subsequent ^ ORCID: Mei Xie, 0009-0000-5352-4017; Gen-Fei Zhu, 0000-0001-6801-6787. © AME Publishing Company. Quant Imaging Med Surg 2026;16(1):105 | [https://dx.doi.org/10.21037/qims-2025-554](https://dx.doi.org/10.21037/qims-2025-554) Page 2 of 8 Xie and Zhu. Laparoscopic surgery for DILI-induced diffuse peritonitis Table 1 Laboratory findings on admission at different time points | Variables | Admission | 24-hour re-evaluation

FAQs

What condition is reported in this case description?

The case describes acute diffuse peritonitis occurring due to drug-induced acute liver injury.

What medications were taken before symptom worsening?

The patient self-administered N-acetyl-para-aminophenol preparations (including GanMaoLingKeLi and New Contech/APAP) and ibuprofen extended-release capsules before later recurrence of fever and discomfort.

How was the diagnosis supported during management?

The diagnosis of drug-induced liver injury was confirmed by intraoperative images and liver biopsy pathology, alongside abnormal laboratory indicators of infection and liver damage.

Sep 30, 2026

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