Replaced right hepatic artery pseudoaneurysm managed with coil embolisation

Area of Science:

• Trauma Surgery
• Interventional Radiology
• Hepatobiliary Medicine

Background:

• Blunt abdominal trauma can cause significant liver injuries.
• Delayed complications such as hemobilia and pseudoaneurysm formation require prompt diagnosis and management.

Observation:

• A 20-year-old male presented with shock following blunt abdominal trauma, initially managed conservatively for a grade 2 liver injury.
• Three weeks later, the patient presented with anemia, fever, and melena, indicative of hemobilia.

Findings:

• Contrast-Enhanced Computed Tomography (CECT) and CT angiography revealed a grade 2 liver injury with a large hematoma, pseudoaneurysm of the replaced right hepatic artery, and a replaced left hepatic artery.
• Upper gastrointestinal endoscopy confirmed hemobilia originating from the ampulla of Vater.

Implications:

• This case highlights the importance of vigilant follow-up for patients with blunt liver trauma, as delayed complications can arise.
• Coil embolization of the hepatic artery pseudoaneurysm is an effective treatment for hemobilia secondary to liver injury.
• Understanding complex hepatic artery anatomy is crucial for successful interventional management.