Presentation
Crush injury.
Patient Data
Liver laceration (grade 4) involving segment VI with active extravasation of contrast with an associated subcapsular hematoma and hemoperitoneum.
Right transverse process fractures of the T12 and L1 vertebrae.
Hepatic angiogram performed, which confirmed active bleeding arising from the segment VI artery. It was not possible to position the catheter immediately adjacent to the site of bleeding and effectively trap with coils alone, hence the decision was made to use NBCA (embolization glue). The bleeding artery and supplying posterior segmental artery were occluded.
Case Discussion
CT trauma scan protocols can vary quite a lot, however, it is always good to check to the arterial and delayed phases to assess for active bleeding. This case also demonstrates the value of endovascular treatment, with the patient avoiding a laparotomy.