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.
- radiology (diagnostics)
- surgical diagnostic tests
- interventional radiology
- vascular surgery
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Contributors RK: research, preparation of the manuscript and submission. LB: consultant, guidelines for management of the case and primary research work. RS: preparation of the manuscript, research and corrections. DK: preparation of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.
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