CriticaLLy ill patients admitted to the intensive care unit (ICU) are prone to various liver injuries resulting from multiple factors. However, in most cases, liver dysfunction is transient. In the following case report the authors describe the unusual occurrence of secondary biliary cirrhosis in a young patient, with no prior history of liver disease, who was admitted to the ICU after a severe motor vehicle accident. In recent years, several case series which describe the appearance of sclerosing cholangitis after hospitalization in the ICU have been reported. This clinical entity was described in patients following a life-threatening injury (trauma, sepsis, etc.) requiring Long-term hospitalization in the ICU (including mechanicaL ventilation and use of vasopressors). This cholangiopathy appears in patients with no previous history of liver disease prior to the life-threatening injury. It is characterized by a gradual increase in cholestatic enzymes and bilirubin with only a moderate increase in the aminotransferases. Cholangiographic imaging may demonstrate multifocal biliary strictures, similar to those described in primary sclerosing cholangitis. In addition, other liver diseases which might explain the cholestasis are excluded (e.g., bile duct obstruction). The disease is characterized by a rapid progression to liver cirrhosis.