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Fukumasa H, Niimi S, Kobayashi M, Uehara T, Okamoto K. Spontaneous Thrombosis of a Hepatic Pseudoaneurysm Following Blunt Liver Injury. Cureus 2023; 15:e39453. [PMID: 37362466 PMCID: PMC10289880 DOI: 10.7759/cureus.39453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Hepatic pseudoaneurysm (HPA) is a rare complication of liver injury in children. Prophylactic embolization is preferable to prevent life-threatening hemorrhage due to pseudoaneurysm rupture. We present the case of a four-year-old boy who sustained a grade III liver injury from blunt abdominal trauma. He was conservatively managed since he was hemodynamically stable. Follow-up contrast-enhanced computed tomography (CECT) performed 10 days following the injury revealed an HPA measuring 4 mm × 4 mm × 3 mm. Herein, we chose conservative treatment for HPA as the patient was asymptomatic and hemodynamically stable. Conservative treatment was successful, and HPA spontaneously resolved 23 days following the injury without radiologic or surgical intervention. Although there are studies reporting asymptomatic HPAs that have spontaneously resolved, the natural history of HPAs remains unknown. Conservative treatment may be an option for asymptomatic HPA; however, to identify factors contributing to spontaneous thrombosis, further evaluation is needed.
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Affiliation(s)
| | - Shingo Niimi
- Pediatrics, Kitakyushu City Yahata Hospital, Kitakyushu, JPN
| | | | | | - Kohji Okamoto
- Surgery, Kitakyushu City Yahata Hospital, Kitakyushu, JPN
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Svarich VG, Svarich VA. [Hemostasis for central rupture of liver in a child]. Khirurgiia (Mosk) 2023:115-119. [PMID: 36748879 DOI: 10.17116/hirurgia2023021115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Blunt abdominal trauma in children accompanied by liver damage occurs in 18-20% of cases. Endovascular embolization is the most common approach for bleeding following central ruptures of liver. Foreign authors published few case reports devoted to successful embolization for central liver ruptures in children. In Russian-language literature, there is one similar report with complicated postoperative period. We present a child with class II blunt liver injury, marginal rupture and central hematoma. The patients underwent suturing of marginal rupture and endovascular embolization without postoperative complications.
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Affiliation(s)
- V G Svarich
- Republican Children's Clinical Hospital, Syktyvkar, Russia.,Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
| | - V A Svarich
- Main Bureau of Medical and Social Expertise in the Republic of Komi, Syktyvkar, Russia
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Tri TT, Thach PN, Duy HP, Thuan LNA, Kiet PT, Duc NM. Post-traumatic intrahepatic pseudoaneurysm: A case of successful conservative treatment. Radiol Case Rep 2022; 18:895-898. [PMID: 36593921 PMCID: PMC9804004 DOI: 10.1016/j.radcr.2022.11.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Although post-traumatic intrahepatic pseudoaneurysms are rare in adults and even more uncommon in children, this serious complication can result in life-threatening bleeding. Most case studies have recommended surgical or endovascular interventions for preventing rupture or managing the bleeding from a ruptured intrahepatic pseudoaneurysm. Some studies also reported pseudoaneurysms could resolve without intervention and advised conservative therapy. In this case study, we describe a 19-month-old boy diagnosed with an intrahepatic pseudoaneurysm, upper gastrointestinal bleeding from the biliary tract, and hematoma infection. The patient received successful conservative treatment. After 36 days, the patient was discharged without signs of gastrointestinal bleeding and the steady shrinkage of the hematoma surrounding the pseudoaneurysm. The pseudoaneurysm and hematoma vanished at follow-up 18 months after the trauma. Conservative treatment may be considered a viable option, particularly for cases of post-traumatic intrahepatic pseudoaneurysms in children.
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Affiliation(s)
- Tran Thanh Tri
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh city, Vietnam
| | - Pham Ngoc Thach
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh city, Vietnam
| | - Ho Phi Duy
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh city, Vietnam
| | - Luu-Nguyen An Thuan
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh city, Vietnam
| | - Phan Tuan Kiet
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh city, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 District 10, Ho Chi Minh City 700000, Viet Nam,Corresponding author.
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Liu X, Sun Q, Sun W, Niu Q, Wang Z, Liu C, Fu T, Geng L, Li X. Severe Blunt Liver Injury Complicated by Delayed Massive Hemobilia in a Toddler: A Case Report and Literature Review. Front Surg 2022; 9:930581. [PMID: 35874128 PMCID: PMC9304685 DOI: 10.3389/fsurg.2022.930581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Xiaoming Liu
- Pediatric Intensive Care Unit, Binzhou Medical University Hospital, Binzhou, China
| | - Qianqian Sun
- Pediatric Intensive Care Unit, Binzhou Medical University Hospital, Binzhou, China
| | - Wenjing Sun
- Pediatric Intensive Care Unit, Binzhou Medical University Hospital, Binzhou, China
| | - Qiong Niu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
| | - Zhu Wang
- Department of Vascular and Interventional Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chen Liu
- Department of Pediatric Surgery, Shanghai Children’s Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
- Correspondence: Lei Geng Xiaomei Li
| | - Xiaomei Li
- Pediatric Intensive Care Unit, Binzhou Medical University Hospital, Binzhou, China
- Correspondence: Lei Geng Xiaomei Li
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Role of interventional radiology in the management of complex pediatric surgical cases. Int J Surg Case Rep 2021; 82:105886. [PMID: 33892448 PMCID: PMC8085693 DOI: 10.1016/j.ijscr.2021.105886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Minimally-invasive techniques offered by interventional radiology (IR) are really helpful in the management of challenging surgical cases. The current report highlights a series of four complex pediatric surgical cases which were successfully managed by specific image-guided techniques. CASE PRESENTATION The first two cases in the present report were infants. One of them had a complicated type-1 choledochal cyst (obstructive jaundice and cholangitis) and was optimized with preoperative percutaneous transhepatic biliary drainage (PTBD) under fluoroscopic guidance. The other child had bilateral ureteropelvic junction obstruction and presented with urosepsis. Due to failure of retrograde stenting on one side, image-guided percutaneous nephrostomy and antegrade stenting were performed. The third and fourth cases had suffered blunt trauma to the abdomen. While one of them developed multiple pseudoaneurysms and arterioportal fistulae in the liver, the other had transection of the right posterior sectoral duct. Angioembolization of the pseudoaneurysms and embolization of the right posterior sectoral duct were performed for them under image-guidance respectively. The post-procedural course of all the above children was uneventful. DISCUSSION Image-guided minimally invasive procedures are associated with less post-procedural pain, early recovery, and better cosmetic outcomes. In specific scenarios, they may even obviate the need for surgical intervention, thereby reducing the overall morbidity. CONCLUSION Interventional radiology offers safe and effective alternatives to operative interventions. They are especially useful in the backdrop of significant morbidities like cholangitis, urosepsis, and trauma.
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Delayed presentation of traumatic hepatic pseudoaneurysm in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kittaka H, Yagi Y, Zushi R, Hazui H, Akimoto H. The investigation of posttraumatic pseudoaneurysms in patients treated with nonoperative management for blunt abdominal solid organ injuries. PLoS One 2015; 10:e0121078. [PMID: 25781957 PMCID: PMC4363468 DOI: 10.1371/journal.pone.0121078] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/28/2015] [Indexed: 11/18/2022] Open
Abstract
Background Posttraumatic pseudoaneurysms (PAs) have been recognized as the cause of delayed hemorrhage complicated with nonoperative management (NOM), although the need for intervention in patients with small-sized PAs and the relationship between the occurrence of PAs and bed-rest has been also unclear. Objectives The purpose of this study was to investigate the clinical history of small-sized PAs (less than 10 mm in diameter) which occurred in abdominal solid organs, and to analyze the relationship between the occurrence of PAs and early mobilization from bed. Methods Sixty-two patients who were successfully managed with NOM were investigated. Mobilization within three days post-injury was defined as “early mobilization” and bed-rest lasting over three days was defined as “late mobilization.” A comparison of the clinical factors, including the duration of bed-rest between patients with and without PAs detected by follow-up CT was performed. Furthermore, a multiple logistic regression model analysis on the occurrence of PAs was performed. Results PAs were detected in 7 of the 62 patients. The One patient with PAs measuring larger than 10 mm received trans-arterial embolization, and the remaining six patients with PAs smaller than 10 mm were managed conservatively. Consequently, no delayed hemorrhage occurred, and the PAs spontaneously disappeared in all of the six patients managed without intervention. The multiple regression model analysis revealed that early mobilization was not a significant factor predicting new-onset PAs. Conclusions Small PAs can be expected to disappear spontaneously. Moreover, early mobilization is not a significant risk factor for the occurrence of PAs.
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Affiliation(s)
- Hirotada Kittaka
- Department of Emergency, Osaka Misihima Emergency Critical Care Center, 11-1, Minami-Akutagawa-cho, Takatsuki City, Osaka Prefecture, Japan
- * E-mail:
| | - Yoshiki Yagi
- Department of Emergency, Osaka Misihima Emergency Critical Care Center, 11-1, Minami-Akutagawa-cho, Takatsuki City, Osaka Prefecture, Japan
| | - Ryosuke Zushi
- Department of Emergency, Osaka Misihima Emergency Critical Care Center, 11-1, Minami-Akutagawa-cho, Takatsuki City, Osaka Prefecture, Japan
| | - Hiroshi Hazui
- Department of Emergency, Osaka Misihima Emergency Critical Care Center, 11-1, Minami-Akutagawa-cho, Takatsuki City, Osaka Prefecture, Japan
| | - Hiroshi Akimoto
- Department of Emergency, Osaka Misihima Emergency Critical Care Center, 11-1, Minami-Akutagawa-cho, Takatsuki City, Osaka Prefecture, Japan
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Late complications after blunt liver injury in a child: Hemobilia with pseudoaneurysm, hemocholecystitis and biloma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Primary hepatic artery embolization in pediatric blunt hepatic trauma. J Pediatr Surg 2012; 47:2316-20. [PMID: 23217897 DOI: 10.1016/j.jpedsurg.2012.09.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/24/2012] [Accepted: 09/30/2012] [Indexed: 11/21/2022]
Abstract
Non-operative management of isolated blunt hepatic trauma is recommended except when hemodynamic instability requires immediate laparotomy. Hepatic artery angioembolization is increasingly used for hepatic injuries with ongoing bleeding as demonstrated by contrast extravasation on the CT scan. It is used primarily or after laparotomy to control ongoing hemorrhage. Hepatic angioembolization as part of multimodality management of hepatic trauma is reported mainly in adults, with few pediatric case reports. We describe our institution experience with primary pediatric hepatic angioembolization and review the literature with regard to indications and complications. Two cases (3 and 8 years old), with high-grade blunt hepatic injuries with contrast extravasation on the CT scan were successfully managed by emergency primary hepatic angioembolization with minimal morbidity and avoided laparotomy. To date, the only reports of pediatric hepatic angioembolization for trauma are 5 cases for acute bleeding and 15 delayed cases for pseudoaneurysm. The role of hepatic angioembolization in the presence of an arterial blush on CT in adults is accepted, but contested in a pediatric series, despite higher transfusion rate and mortality rate. We propose that hepatic angioembolization should be considered adjunct treatment, in lieu of, or in addition to emergency laparotomy for hemostasis in pediatric blunt hepatic injury.
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Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance. Radiol Oncol 2012; 46:198-206. [PMID: 23077458 PMCID: PMC3472948 DOI: 10.2478/v10019-012-0028-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 01/02/2012] [Indexed: 02/08/2023] Open
Abstract
Background To 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. Results The 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. Conclusions Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.
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