Delayed appearance of hepatic artery pseudoaneurysm and an arterio-biliary fistula secondary to biliary leakage and bilioma formation in a liver trauma patient and its management through transarterial embolization

Abstract

Background Pseudoaneurysm and arterio-biliary fistulas are infrequent complications of surgery or iatrogenic trauma, accidental trauma, tumors, vascular malformations, infection, and inflammation of the biliary tract. In a liver trauma patient, they evolve immediately secondary to direct vascular injury and usually present with either drop in hemoglobin level or hemobilia due to bleeding into the peritoneal space or biliary system. In the present case, there were no clinical features of hemobilia or upper gastrointestinal bleeding. Moreover, the hepatic artery pseudoaneurysm and arterio-biliary fistula evolved after a latent period of a few weeks, secondary to the toxic effects of the bile on the vessel walls due to biloma formation or biliary leakage, which is exceptionally uncommon. Case presentation This 19-year-old male presented with a severe liver injury complicated by forming a biloma, followed by the development of a pseudoaneurysm and an arterio-biliary fistula. The appropriate hepatic artery branch was successfully embolized using an endovascular approach. Conclusions In a liver trauma patient, the latency period for developing a pseudoaneurysm and an arterio-biliary fistula can be from a few days to a few months due to direct vascular injury or toxic effects of the bile on the adjacent vessel walls secondary to bile leakage. Development of hepatic artery pseudoaneurysm and an arterio-biliary fistula after a latent period of a few weeks, secondary to the toxic effects of the bile on the vessel walls due to biloma formation or biliary leakage, is exceptionally uncommon. So, these liver trauma patients require close monitoring and follow-up for early detection and treatment of pseudoaneurysm and arterio-biliary fistula, especially when there are clinical or imaging features of bile leakage or biloma formation. Endovascular treatment of hepatic artery pseudoaneurysm and arterio-biliary fistulas is a safe and effective method.