Gastric Artery Injury Due to Blunt Abdominal Trauma

Abstract

Gastric artery injury resulting from blunt abdominal trauma is rare, with only eight previous cases documented in the published literature. Our report describes a case involving an injury to the right gastric artery with concomitant injuries to the liver and spleen, for which arterial embolization targeting the right gastric artery was performed. The patient, a 66-year-old woman without any remarkable medical history, was involved in a motor vehicle accident. She was brought to the hospital in a state of shock and complaining of upper abdominal pain. Contrast-enhanced CT indicated hepatic and splenic injuries, intra-abdominal hemorrhaging, and effusion of contrast medium, suggesting involvement of the right gastric artery. Subsequent angiography confirmed irregularities in the diameter of the right gastric artery, prompting coil embolization. A conservative therapeutic approach was selected due to the absence of evidence regarding active hemorrhage or vascular injury within the hepatic or splenic regions. The patient remained clinically stable following the embolization, without any sequelae. Arterial embolization is warranted if preoperative contrast CT indicates signs of hemorrhage, even if hemostasis is ostensibly attained during angiography. Our findings allude to the feasibility of non-operative management (NOM) rather than laparotomy for cases of gastric artery injury.

Keywords: airbag-associated injury; blunt abdomen trauma; gastric artery; interventional radiology-guided embolization; ruptured pseudoaneurysm; selective non-operative management.

Figure 1. Contrast-enhanced computed tomography

Contrast-enhanced computed tomography was conducted at the time of injury, with panes A and C showing the arterial phase and panes B and D the venous phase. The scan shows hepatic injury, splenic injury, and intra-abdominal hemorrhage, along with the presence of extravascular leakage of the contrast medium (red arrow).

Figure 2. Reconstructed contrast-enhanced computed tomography

Reconstructed contrast-enhanced CT was performed at the time of injury, with pane A showing the axial, pane B the coronal, and pane C the sagittal images. Since there was a pseudoaneurysm in the right gastric artery and continuous extravasation (red arrow), it was judged that the right gastric artery was the injured vessel.

Figure 3. Celiac artery angiography

There are no signs of an aneurysm or active hemorrhage. However, irregularities in the diameter of the right gastric artery are apparent.

Figure 4. Right gastric artery angiography

The right gastric artery is selectively contrast-enhanced, but there is no evidence of active bleeding.

Figure 5. Angiography performed after the coil embolization of the right gastric artery

The right gastric artery has been embolized completely.