Replaced right hepatic artery pseudoaneurysm managed with coil embolisation

Abstract

A 20-year-old male patient presented to our emergency surgery department with blunt trauma to the abdomen and in a state of shock. The patient was resuscitated and a Contrast-Enhanced Computed Tomography (CECT) was done which showed a grade 2 liver injury involving segment VIII. The patient was managed conservatively and discharged after 8 days. The patient again presented after 3 weeks with severe anaemia, fever and melena. An upper gastrointestinal endoscopy revealed bile mixed with blood at the ampulla of Vater, consistent with haemobilia. CT angiography showed grade 2 injury of the liver with large haematoma in segment VIII. A large right subcapsular collection, a saccular area consistent with pseudoaneurysm of the replaced right hepatic artery arising from the superior mesenteric artery, was seen. A replaced left hepatic artery arising from the left gastric artery was also observed. The patient underwent right hepatic artery coil embolisation, with postprocedure digital subtraction scan showing no extravasation of contrast. The patient recovered well in the follow-up.

Keywords: interventional radiology; radiology (diagnostics); surgical diagnostic tests; trauma; vascular surgery.

Figure 1

Pre-embolisation Contrast-Enhanced Computed Tomography of the abdomen showing liver laceration and haematoma.

Figure 2

Pre-embolisation CT angiography showing replaced right (RT) hepatic artery from the superior mesenteric artery.

Figure 3

Postembolisation status of the pseudoaneurysm.