Hepatic infarction after transcatheter arterial embolization for blunt liver injury

Abstract text (incl. references and figure legends)

Case history

A 70-year-old woman with diabetes was admitted to the trauma emergency room after being injured by rolling down in the mountains.

Clinical findings

The initial vital sign was stable. The initial computed tomography (CT) scan showed liver laceration grade IV with active bleeding and hemoperitoneum.

Investigation/Results

Transarterial embolization was planned. After selective celiac and hepatic angiography, multiple ruptures and pseudoaneurysm were identified in the right hepatic artery. Embolization was performed using gelatin sponge slurry and microcoils in the right anterior hepatic artery and the right posterior hepatic artery. After the procedure, serum lactate level rose to 12.9 mmol/L. And the patients presented a confused mentality with a fever of 38.8 degrees and hypoglycemia.

Diagnosis

Follow-up CT showed hepatic infarct accompanied by secondary infection at the previous embolization site.

Therapy and Progressions

The patient underwent right hemihepatectomy due to right lobe infarction. After surgery, the patient fell into septic shock. The patient died without recovery of spontaneous circulation despite receiving cardiopulmonary resuscitation due to cardiac arrest.

Comments

Since the liver receives dual blood supply from the hepatic artery and portal vein, embolization can be safely performed if there is a wide parenchymal injury accompanied by arterial bleeding. In the absence of portal flow, infarction or abscess may occur after hepatic arterial embolization. It is a very rare that infarction progresses quickly within 29 hours of the procedure, even when the portal vein is intact.

References

Fujiwara H, Kanazawa S, Hiraki T, Mimura H, Yasui K, Akaki S, Yagi T, Naomoto Y, Tanaka N, Hiraki Y. Hepatic infarction following abdominal interventional procedures. Acta Med Okayama. 2004;58(2):97-106.

Figure

CT showed liver laceration (A) and embolization was performed (B). Hepatic infarction was identified on follow-up CT (C).

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