Post-traumatic intrahepatic pseudoaneurysm: A case of successful conservative treatment

Abstract

Although post-traumatic intrahepatic pseudoaneurysms are rare in adults and even more uncommon in children, this serious complication can result in life-threatening bleeding. Most case studies have recommended surgical or endovascular interventions for preventing rupture or managing the bleeding from a ruptured intrahepatic pseudoaneurysm. Some studies also reported pseudoaneurysms could resolve without intervention and advised conservative therapy. In this case study, we describe a 19-month-old boy diagnosed with an intrahepatic pseudoaneurysm, upper gastrointestinal bleeding from the biliary tract, and hematoma infection. The patient received successful conservative treatment. After 36 days, the patient was discharged without signs of gastrointestinal bleeding and the steady shrinkage of the hematoma surrounding the pseudoaneurysm. The pseudoaneurysm and hematoma vanished at follow-up 18 months after the trauma. Conservative treatment may be considered a viable option, particularly for cases of post-traumatic intrahepatic pseudoaneurysms in children.

Keywords: Hemobilia; Hepatic artery pseudoaneurysm; Hepatic trauma.

Fig. 1

Image of liver injury on contrast-enhanced abdominal computed tomography imaging on the day of the injury and 15 and 36 days after the injury. (A) Liver parenchymal hematoma on computed tomography (CT) imaging at the time of admission (Day 1). (B) Liver parenchymal hematoma with internal pseudoaneurysm (arrow) on CT imaging 15 days after the injury. (C) The parenchymal hematoma was reduced in size (arrowhead) with a pseudoaneurysm mass (arrow) 36 days after the injury.

Fig. 2

Computed tomography imaging 18 months after injury. Computed tomography imaging with (A) and without (B) contrast performed 18 months after injury revealed that the hematoma and aneurysm had disappeared, and the liver parenchyma was scarred, with nodular calcifications.