Posttraumatic intrahepatic pseudoaneurysm in a child managed by coil angioembolization: a case report and literature review

Hardcastle, Timothy Craig; Reitz, Deneys; Hollander, Daan den; Rodseth, Reitze; Muckart, D. J. J.

doi:10.1016/j.jpedsurg.2010.02.119

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…Surgical procedures still play an important role in the management of patients with unstable hemodynamics or failure following selective angiographic embolization (22,27,36,50,59). A flowchart (Figure 3) was recommended to provide a suitable approach to deal with this rare but life-threatening condition in accordance with the literature (15,17,33,36,46,50,52,(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64) and our preliminary experience.…”

Section: Discussionmentioning

confidence: 76%

“…Hemobilia may stop because of blood clot formation after the diversion of bile with nasobiliary drainage (57). Selective transcatheter arterial embolization as a useful therapeutic method for traumatic hepatic pseudoaneurysm and/or its rupture into the biliary duct remains the first-line choice for the majority of cases (17,31,35,36,39,40,50,55,58), with 26/35 (74.28%) of patients undergoing successful angiographic embolization, as shown in Table 1. Surgical procedures still play an important role in the management of patients with unstable hemodynamics or failure following selective angiographic embolization (22,27,36,50,59).…”

Section: Discussionmentioning

confidence: 99%

“…In conclusion, massive upper gastrointestinal bleeding in patients with a history of severe blunt liver trauma should be highly suspicious of hemobilia. The diagnosis can be made via CT angiography and hepatic artery angiography (16,17,36,41). Based on the age-specific characteristics of children, a multidisciplinary team, especially experienced interventional radiologists, is vital for the diagnosis and management of this rare but life-threatening condition to achieve a good outcome (18,20,37).…”

Section: Discussionmentioning

confidence: 99%

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Severe Blunt Liver Injury Complicated by Delayed Massive Hemobilia in a Toddler: A Case Report and Literature Review

Liu

Sun

et al. 2022

Front. Surg.

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IntroductionUnintentional injuries remain a leading cause of disability among children. Although most of the pediatric patients suffering blunt liver injury can be successfully treated with non-operative therapy, the diagnosis and management of delayed life-threatening hemobilia following severe blunt liver injury, especially in the pediatric population, remain a challenge for clinicians.Case PresentationA previously healthy 2-year-old girl suffered a severe blunt liver injury related to an electric bike, which was inadvertently activated by herself. She initially received non-operative therapy and was in a stable condition in the first 2 weeks. On the 16th and 22nd postinjury days, the patient presented with life-threatening massive hemobilia, which was confirmed via repeat emergent gastroscopy and hepatic arterial angiography. An emergency selective transarterial embolization of the involved branch of the left hepatic artery was successfully performed. The patient recovered uneventfully, and long-term follow-up was needed owing to a mild dilatation of the left intrahepatic bile duct.DiscussionIncidental injury in children should be considered as a major public health issue and preventive measures should be taken to reduce its occurrence. Delayed massive hemobilia after severe blunt liver trauma is rare, and its accurate and timely diagnosis via emergency hepatic arterial angiography and selective angioembolization may allow prompt and optimal management to achieve good outcomes in the pediatric population.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Severe Blunt Liver Injury Complicated by Delayed Massive Hemobilia in a Toddler: A Case Report and Literature Review

Liu

Sun

et al. 2022

Front. Surg.

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“…As compared to traumatic splenic aneurysms, the incidence of rupture is higher in hepatic aneurysms. Therefore, some surgeons prefer to embolize these aneurysms prophylactically as delayed hemorrhage is often noticed once these patients are mobilized [ [13] , [14] , [15] ]. In the present case, the development of a hypotensive episode with a fall in hematocrit directed us to perform selective angioembolisation of the anterior divisions of the left and right hepatic arteries using multiple coils and PVA.…”

Section: Discussionmentioning

confidence: 99%

Role of interventional radiology in the management of complex pediatric surgical cases

Anand

Sandlas

Sangani

et al. 2021

International Journal of Surgery Case Reports

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Highlights Interventional radiological (IR) procedures are safe alternatives to operative interventions in complex pediatric surgical scenarios. These minimally-invasive procedures are associated with less post-procedural pain, early recovery and better cosmetic outcomes. Temporizing IR procedures play a key role in preoperative optimization of children with complicated urinary tract and biliary tract obstructions. IR can obviate the need for surgery in post-traumatic arterioportal fistulae (intrahepatic) and sectoral biliary duct transection.

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“…The transvenous approach can be considered and used when there are multiple arteriovenous fistulas, or when embolisation via the trans-arterial approach is technically unsuccessful. Closure by embolisation with Gelfoam, steel coils, detachable balloons, n-butyl cyanoacrylate, or bucrylate has proven to be feasible 2,7,19,22,29. The choice of embolic agent should be based on the underlying mechanism of the shunts and their angio-architecture.…”

Section: Discussionmentioning

confidence: 99%

Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance

Meng¹,

Yang²,

Fu³

et al. 2012

Radiology and Oncology

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BackgroundTo evaluate the usefulness of the routine sonographic evaluation of the pattern of fluctuate portal velocity tracings and the hepatic veins for the diagnosis of arterioportal fistula (APF) and cardiogenic trans-sinusoidal shunting (CTS).Materials and methods.Color Doppler flow imaging and pulsed-wave Doppler (PW) examinations of the portal vein were performed in 282 subjects. The waveforms of the velocity tracings in the portal main trunk and its branches were determined to infer APF or CTS. Suspected cases of APFs or CTSs were always confirmed by echocardiography, contrast-enhanced ultrasound, computed tomography, or digital subtraction angiography findings. The portal maximum velocity (Vmax), minimum velocity(Vmin), Vmax/Vmin, arterial peak systolic velocity and resistance index, and venous reverse and forward velocities were used to estimate their haemodynamics.ResultsThe waveform of the velocity tracing for the draining portal vein of APF was typically arterial-like or diphase, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape. The flow in the affected portal vein was always hepatofugal in an intrahepatic patient, whereas a hepatopetal flow was observed in an extrahepatic APF patient. The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing. The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.ConclusionsPortal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

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Posttraumatic intrahepatic pseudoaneurysm in a child managed by coil angioembolization: a case report and literature review

Cited by 10 publications

References 9 publications

Severe Blunt Liver Injury Complicated by Delayed Massive Hemobilia in a Toddler: A Case Report and Literature Review

Severe Blunt Liver Injury Complicated by Delayed Massive Hemobilia in a Toddler: A Case Report and Literature Review

Role of interventional radiology in the management of complex pediatric surgical cases

Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance

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