The case illustrates two important concepts:

Grade VI hepatic injury: lacerations involving the whole width of the affected region.

Most of the features of CT hypotension complex including (hypo-enhancement of solid organs, collapsed IVC, decreased caliber of the aorta, hyper-enhancing adrenals, thickening and hyper-enhancing of the bowel walls (previously shock bowel).

The patient was unstable when he arrived at the ER and had an episode of cardiac arrest. After proper resuscitation in the ER, the patient underwent a CT scan and after that he transferred immediately to the OR.

According to the surgery report, the patient suffered from an extensive liver laceration along the course of the middle hepatic vein and many smaller branching lacerations mainly involving the right lobe with injury to the retro-hepatic IVC. The patient underwent right hepatic lobectomy and the retro-hepatic cava injury was repaired. However, despite all the efforts to save the patient, he continued to be hemodynamically unstable and died on the next day of his admission.