administrated in the hospital three days ago. In this regard, the possibility of RILD in our case is very rare. Of particular interest, spontaneous pneumoperitoneum caused by ruptured hepatic lesions in this case was observed in the perihepatic space. Spontaneous pneumoperitoneum of infection in an intra-abdominal organ is extremely rare, and only a few cases have been reported.16 As mentioned in another report, emphysematous hepatitis is similar to the findings of emphysematous pyeolonephritis.6 Empysematous pyelonephritis is classified into two subtypes (types I and II) according to findings on CT scan.17,18 Type I emphysematous pyelonephritis refers to renal parenchymal necrosis with either absence of fluid content or the presence of a streaky or mottled gas pattern and type II refers to the presence of renal or perirenal fluid accompanied by a bubbly gas pattern or gas in the collecting system.17,18 Considering these findings, our case appears to be equivalent to type I emphysematous pyelonephritis and we can diagnose as emphysematous hepatitis. Late stent blockage by biliary sludge is a major complication. In one study, adherence of Clostrium sp. to the stent occurred as few as 6 days after stent placement and the bacterial density appeared to be proportional to the length of time the stent remained.19 However, the authors reported that though few enrolled patients had symptoms of fever, pain, and leukocytosis at the time of stent removal, most of the patients in their study had no clinical symptoms of biliary infection. Inhibition of growth of Clostridium perfringens by bile acids has been reported.20 In another study of patients who received chemotherapy with a biliary stent, the incidence of stent related complications, such as infection and stent blockage, was not significant.21 Therefore, it is our cautious conclusion that the role of the biliary stent in this case may be very limited. The clinical outcome of emphysematous hepatitis appears to be fatal, as seen in our case and in other reports.6 Therefore, an aggressive therapeutic modality is emphasized and surgical intervention should not be delayed in patients with emphysematous hepatitis who do not show substantial improvement after intensive medical therapy. Unfortunately, in our case, the rapidly aggravating condition did not provide an opportunity for rescue. In conclusion, we have described a very rare case of emphysematous hepatitis featuring total emphysematous replacement of hepatic prarenchyme, leading to death. Jung Ho Kim, et al. Rare case of emphysematous hepatitits 97 REFERENCES 1. Grayson DE, Abbott RM, Levy AD, Sherman PM. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics 2002;22:543-561. 2. Urban BA, McCormick R, Fishman EK, Lillemoe KD, Petty BG. Fulminant Clostridium septicum infection of hepatic metastases presenting as pneumoperitoneum. 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