Late development of giant hepatic artery pseudoaneurysm following abdominal trauma due to tire blast: case report and literature review

Abstract

Giant hepatic artery pseudoaneurysm is rare but could have a significant implication. A 35-year-old male was severely injured by a truck tire explosion and presented with hypotension and positive focused assessment with sonography in trauma scan. After resuscitation, abdomen computed tomography (CT) scan showed a Grade 4 liver injury. The patient was admitted to the intensive care unit, and the liver injury was treated conservatively. Seventeen days later, he developed abdominal pain with deep epigastric tenderness. Repeated abdomen CT scan detected a giant hepatic artery pseudoaneurysm. Embolization was achieved using gel foam with the placement of six microcoils. The patient had an uneventful recovery. Late development of giant hepatic artery pseudoaneurysm is a rare complication of hepatic trauma and could be life-threatening. Timely identification and treatment with endovascular intervention are crucial. We recommend, especially when dealing with trauma related to blast injury, follow-up images for patients who develop symptoms suggestive of hepatic injury.

Severe Blunt Liver Injury Complicated by Delayed Massive Hemobilia in a Toddler: A Case Report and Literature Review

“…Surgical procedures still play an important role in the management of patients with unstable hemodynamics or failure following selective angiographic embolization (22,27,36,50,59). A flowchart (Figure 3) was recommended to provide a suitable approach to deal with this rare but life-threatening condition in accordance with the literature (15,17,33,36,46,50,52,(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64) and our preliminary experience.…”

“…Hemobilia may stop because of blood clot formation after the diversion of bile with nasobiliary drainage (57). Selective transcatheter arterial embolization as a useful therapeutic method for traumatic hepatic pseudoaneurysm and/or its rupture into the biliary duct remains the first-line choice for the majority of cases (17,31,35,36,39,40,50,55,58), with 26/35 (74.28%) of patients undergoing successful angiographic embolization, as shown in Table 1. Surgical procedures still play an important role in the management of patients with unstable hemodynamics or failure following selective angiographic embolization (22,27,36,50,59).…”

Complications of Liver Trauma: A Comprehensive Analysis of Impact, Assessment and Clinical and Surgical Management Strategies

“…The evaluation of liver trauma, to determine the best treatment, involves imaging tests, such as Computed Tomography or Doppler Ultrasonography, considering local availability and resources. These exams make it possible to identify hemorrhages, contusions, lacerations, vessel avulsions and other conditions that may require invasive interventions (MAHMOOD I. et al, 2021). Furthermore, it is crucial to identify injuries to organs and structures adjacent to the liver for the patient's overall well-being.…”

“…In extreme cases, liver transplantation is considered, taking into account the availability of the organ, surgical feasibility and markers of compatibility between donor and recipient (MITRICOF B. et al, 2023). Delicate conditions, such as hematomas, require careful analysis due to the high risk of complications and rapid patient decline, especially when associated with hepatic pseudoaneurysm, which can result in hemorrhagic shock (MAHMOOD I. et al, 2021). Avulsion-related injuries require accurate identification of the affected vessels and adequate containment (MITRICOF B. et al, 2023).…”

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare vascular pathology, part II

“…Hepatic artery pseudoaneurysm can develop following liver transplantation [8], but may occur with a frequency between 0.06% and 0.6% also after (laparoscopic) cholecystectomy [9][10][11][12]. Non-surgical reasons include blunt abdominal trauma [13], acute pancreatitis [14,15], and very rare infectious disease of the liver such as amoebic abscess [16][17][18]. Liver biopsy is a safe method, but rarely, the development of a pseudoaneurysm is also possible [19].…”