Fatal Hepatic Necrosis after Transcatheter Arterial Embolization for Blunt Hepatic Trauma

Abstract

Abstract:Hepatic necrosis after transcatheter arterial embolization (TAE) is rare because of the dual blood supply to the hepatic parenchyma via the portal vein and hepatic artery. We describe a patient with blunt hepatic injury who had a portal-systemic venous shunt in the right posterior segment of the liver and who suffered a fatal hepatic necrosis after TAE. A 74-year-old female with blunt hepatic injury was treated by TAE: both the right hepatic artery and middle hepatic artery were embolized using gelatin sponge particles. She developed multiple organ failure and died four days after the TAE. Autopsy revealed massive necrosis in the right lobe and left medial segment of the liver. To the best of our knowledge, this is the first report of hepatic necrosis after TAE for blunt liver trauma related to a portal-systemic venous shunt.

Hepatectomy for massive hepatic necrosis after transcatheter arterial embolization hemostasis for hepatic hemorrhage following hepatic trauma: A case report

“…There are only a few case reports of HMN associated with liver trauma treated with hepatectomy 11,12 . Although the right lobectomy was successful in this case, surgical debridement of the necrotic area alone may have been sufficient to shorten the operative time and preserve liver function.…”

“…There are only a few case reports of HMN associated with liver trauma treated with hepatectomy. 11,12 Although the right lobectomy was successful in this case, surgical debridement of the necrotic area alone may have been sufficient to shorten the operative time and preserve liver function. Although some retrospective reports have compared debridement with hepatectomy, 1 at this point there seems to be no evidence favoring either approach.…”

Primary angioembolization in liver trauma: major hepatic necrosis as a severe complication of a minimally invasive treatment—a narrative review

“…Additional damages have not been recognized with this diagnostic investigation, and after the worsening of her clinical conditions, a contrast-enhanced CT revealed lacerations of the liver, hemoperitoneum, arterial contrast blush, and portal-systemic venous shunt. After hepatic trauma can be multiple injuries that remain unrecognized if performing an unenhanced CT scan [ 18 ]. CT scan also has an essential role in identifying necrotic complications: some authors recommend performing it only in case of clinical deterioration during the follow-up period after the AE procedure.…”