Delayed haemorrhage and pseudoaneurysms following liver trauma

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Hepatobiliary Surgery

Background:

• Delayed Hemorrhage (DH) and Hepatic Artery Pseudoaneurysms (HAPAs) are known, though rare, complications after liver trauma.
• The natural history of HAPAs and their potential link to DH remain poorly understood.
• Some research suggests DH may originate from HAPAs.

Purpose of the Study:

• To determine the incidence of DH and HAPA after liver trauma.
• To review the management of these conditions.
• To explore a potential association between DH and HAPA.

Main Methods:

• Retrospective analysis of liver trauma cases over 14 years.
• Case-control study comparing patients with DH and HAPA to matched controls.
• Analysis included injury grade, transfusion requirements, and imaging findings.

Main Results:

• DH occurred in 2.2% and HAPA in 1.6% of 450 liver trauma patients.
• Both DH and HAPA groups required more transfusions and had lower/decreasing hemoglobin levels.
• No HAPA patients had significant hemoperitoneum, and no DH patients had concurrent HAPA identified.

Conclusions:

• DH and HAPA are infrequent complications of liver trauma.
• DH following liver trauma was not associated with HAPA on imaging.
• HAPAs appear to cause insidious bleeding and hemoglobin decline, not catastrophic rupture.