Post traumatic hepatic artery pseudoaneurysm: a tertiary care centre experience

Abstract

In blunt trauma abdomen, liver is the most commonly injured organ after spleen. Management of blunt hepatic injury has shifted from operative to non-operative management NOM in hemodynamically stable patients. Main cause of failure of NOM is hemodynamic instability due to re-bleeding or secondary hemorrhage due to rupture of capsular hematoma. Post traumatic hepatic artery pseudoaneurysm HAP as a cause of failure of NOM is rare, reported in about 1.2%. HAP requires early intervention by angiographic embolisation or surgery to prevent catastrophic event. Here, we report our experience with four cases of HAP managed in our centre in past three years. Three patients were managed by selective angioembolisation and one patient was treated by surgery. All patients had uneventful recovery and are asymptomatic on follow-up. HAP is a rare life threatening complication which can present even after successful NOM as a delayed presentation. All symptomatic pseudoaneurysm has to be managed by angioembolisation or surgery depending on hemodynamic stability.

Post-traumatic hepatic artery pseudoaneurysm with recurrent hemoperitoneum and repeated laparotomies treated by endovascular coil embolization

“…[ 1 3 ] CECT abdomen scan with angiography is the investigation of choice to detect the HAP. [ 2 4 ]…”

“…However, due to the very high risk of rupture, all HAPs should be treated by interventional radiology or surgery. [ 2 ] Endovascular embolization is currently the treatment of choice for HAP in hemodynamically stable patients, while unstable patients or those with failed angioembolisation are candidates for surgery. [ 1 2 ]…”

“…[ 2 ] Endovascular embolization is currently the treatment of choice for HAP in hemodynamically stable patients, while unstable patients or those with failed angioembolisation are candidates for surgery. [ 1 2 ]…”

“…Glue n-butyl cyanoacrylate (NBCA) can be used as an endovascular embolic agent, especially if the pseudoaneurysm is arising from the distal branch and not amenable to treatment by coil or stent placements. [ 1 2 4 5 ] Other embolizing agents are gelfoam and polyvinyl alcohol (PVA) particles. Gelfoam is a temporary embolizing agent with subsequent recanalization of the vessel.…”

“…The necrosis may get infected, leading to abscess formation, and prevented by post-procedure antibiotic prophylaxis. [ 2 4 5 ]…”