Liver laceration: active bleeding with embolisation

Case contributed by Dr Henry Knipe

Presentation

Crush injury.

Patient Data

Age: 50
Gender: Male

Liver laceration (grade 4) involving segment 6 with active extravasation of contrast with an associated subcapsular haematoma and haemoperitoneum. 

Right transverse processes of the T12 and L1 vertebral body. 

Modality: DSA (angiography)

Hepatic artery 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. The bleeding artery, and supplying posterior segmental artery was 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. 

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Case Information

rID: 46114
Case created: 22nd Jun 2016
Last edited: 7th Jul 2016
Inclusion in quiz mode: Included

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