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Traumatic hepatic artery pseudoaneurysm with hemobilia
M A Croce1, T C Fabian, J P Spiers
1Department of Surgery, University of Tennessee, Memphis 38163.
American Journal of Surgery
|September 1, 1994
Summary
Hepatic artery pseudoaneurysm (HPA) with hemobilia is a rare complication of liver trauma. Early embolization is effective for small, non-septic pseudoaneurysms, while larger or infected cases require surgery.
Area of Science:
- Hepatobiliary Surgery
- Vascular Surgery
- Trauma Surgery
Background:
- Hepatic artery pseudoaneurysm (HPA) with hemobilia is an uncommon complication following liver trauma.
- Initial surgical management of liver injuries can influence HPA development, complicating definitive treatment.
Purpose of the Study:
- To analyze the incidence and outcomes of hepatic artery pseudoaneurysm with hemobilia after liver injury.
- To evaluate management strategies and patient outcomes for this rare complication.
Main Methods:
- Prospective analysis of 482 consecutive patients with liver injury.
- Identification of 6 patients (1.2%) who developed HPA with hemobilia.
- Review of patient data including injury type, diagnostic methods (angiography, hepatobiliary scans), and treatment approaches.
Main Results:
- HPA with hemobilia occurred in 1.2% of liver injury patients, with equal incidence in blunt and penetrating trauma.
- All patients presented with massive upper gastrointestinal hemorrhage; 80% had associated bile leaks.
- Successful embolization was achieved in one non-septic patient with a small cavity. Five septic patients with large cavities required operative intervention, with significant morbidity and mortality.
Conclusions:
- Bile leak is a predisposing factor for HPA with hemobilia.
- Embolization is a suitable treatment for small, non-septic HPAs.
- Large cavities and/or sepsis necessitate surgical débridement and drainage, potentially including hepatic resection, after securing vascular control.