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Deep circumflex iliac artery-related hemoperitoneum formation after surgical drain placement: successful
Sang Woo Park1, Seong-Hwan Chang, Ik Jin Yun
1Department of Radiology, Konkuk University Hospital, Seoul, Republic of Korea.
Insights
A liver transplant patient experienced significant blood loss due to a deep circumflex iliac artery (DCIA) bleed. Transcatheter embolization successfully stopped the hemorrhage, resolving the post-transplant complication.
Area of Science:
- Hepatobiliary surgery
- Interventional radiology
- Vascular imaging
Background:
- Living donor liver transplantation is a complex procedure for end-stage liver disease.
- Post-transplant hemorrhage is a serious complication requiring prompt diagnosis and management.
- Hepatocellular carcinoma and liver cirrhosis are common indications for liver transplantation.
Observation:
- A 53-year-old woman developed severe anemia (hemoglobin 6.3 g/dl) three days post-liver transplant.
- Contrast-enhanced computed axial tomography (CAT) scan revealed hemoperitoneum in the right perihepatic space.
- Angiography identified active bleeding (extravasation) from the deep circumflex iliac artery (DCIA) near a surgical drain.
Findings:
- The source of bleeding was identified as branches of the deep circumflex iliac artery (DCIA).
- No abdominal wall hematoma or pseudoaneurysm was detected.
- Transcatheter embolization using N-butyl cyanoacrylate effectively occluded the bleeding DCIA branches.
Implications:
- Transcatheter arterial embolization is a viable treatment for post-transplant arterial hemorrhage.
- Early diagnosis via advanced imaging is crucial for managing vascular complications after liver transplantation.
- Successful embolization can prevent the need for re-operation and improve patient outcomes.
Abstract:
A 53-year-old woman with liver cirrhosis and hepatocellular carcinoma underwent living donor liver transplantation. After transplantation, her hemoglobin and hematocrit levels decreased to 6.3 g/dl and 18.5%, respectively, during the course of 3 days. A contrast-enhanced abdominal computed axial tomography (CAT) scan showed a hemoperitoneum in the right perihepatic space with no evidence of abdominal wall hematoma or pseudoaneurysm formation. An angiogram of the deep circumflex iliac artery (DCIA) showed extravasation of contrast media along the surgical drain, which had been inserted during the transplantation procedure. Transcatheter embolization of the branches of the DCIA was successfully performed using N-butyl cyanoacrylate.
