摘要Rationale: As an uncommon manifestation of congestive heart failure, congestive hepatopathy requires an early diagnosis in order to render appropriate care. Misdiagnosis as intraabdominal sepsis may lead to erroneous initial intervention, such as fluid boluses, that can potentially tip an already sick patient with poor reserves over into an extreme state. Patient's Concern: A 65-year-old man was brought to the emergency department for excruciating abdominal pain, vomiting and jaundice. He also had lower limb pitting edema and was hypotensive en route. Diagnosis: Congestive hepatopathy. Interventions: Intravenous furosemide and fluid restriction. Outcomes: The patient declined admission to the cardiology ward and discharged himself against medical advice after his condition was improved in the emergency department. Lessons: It is important to pay attention to acute abdominal pain induced by extraabdominal pathologies. In this case of acute decompensated congestive heart failure, early recognition of the cause makes a difference to the management.