Embolization management of post-traumatic hepatic pseudoaneurysm: A compelling case report

Abstract

Pseudoaneurysm of the hepatic artery, first described by Sandblom in 1948, is an uncommon complication of hepatic trauma. Since then, numerous cases have been documented. Post-traumatic hepatic pseudoaneurysm of the hepatic artery is a rare complication, occurring in approximately 1.2% of patients with traumatic liver injury.

We report the case of a 25-year-old patient with a history of Behçet's disease, treated with colchicine, who sustained a traffic accident resulting in hepatic contusion and rib fractures. The patient developed right hypochondriac pain, jaundice, and gastrointestinal hemorrhage, consistent with Quincke's triad, suggesting pseudoaneurysm rupture. The diagnosis was confirmed by computed tomography (CT), and the patient underwent successful percutaneous embolization.

Despite established guidelines for managing blunt abdominal trauma, the approach to post-traumatic hepatic pseudoaneurysm remains controversial. While some advocate for prophylactic angiographic embolization to prevent bleeding, others favor conservative management due to the potential for spontaneous resolution. Currently, minimally invasive percutaneous embolization is the primary treatment modality. In cases where embolization fails, a transhepatic approach may serve as an alternative. The angioscan is a reliable diagnostic tool. Management is now predominantly minimally invasive, guided by radiological imaging. When conventional angiographic treatment fails, the transhepatic approach can be considered.