Combined Percutaneous and Angiographic Thrombosis of a Traumatic Hepatic Artery Pseudoaneurysm in a Child

Percutaneous thrombin injection in an infant to treat hepatic artery pseudoaneurysm after failed embolization

Percutaneous thrombin injection has been described in case reports as an alternative to surgical intervention for the treatment of hepatic artery pseudoaneurysms associated with high-grade liver lacerations in adults. However, there is limited description in the literature of this technique being applied in children, particularly in preadolescents, and no published literature describes its use in infants. The procedure can be performed by pediatric radiologists and pediatric interventional radiologists skilled in ultrasound-guided aspiration techniques. We report successful application of percutaneous thrombin injection in an infant to treat a pseudoaneurysm of a left hepatic arterial branch in an 11-month-old girl with a grade IV liver laceration after superselective transcatheter arterial embolization failed to achieve thrombosis.

Role of sonography in the diagnosis and treatment of a large iatrogenic pseudoaneurysm of a hepatic artery

We report the sonographic (US) findings in a case of successful combined endovascular and percutaneous treatment of a large hepatic artery pseudoaneurysm, responsible of massive hemobilia, in a patient with coexisting portal vein thrombosis. Previous percutaneous transhepatic biliary drainage placement caused the pseudoaneurysm. US identified the pseudoaneurysm and showed the biliary drain crossing the pseudoaneurysm lumen. After partial endovascular coils embolization of the pseudoaneurysm lumen, the biliary catheter was removed and the entry site of the catheter in the aneurysmal sac was occluded with an Amplatzer vascular plug released under US guidance. The residual lumen was then completely embolized with coils and Lipiodol.

Blunt intraabdominal arterial injury in pediatric trauma patients: injury distribution and markers of outcome

BACKGROUND

The epidemiology of pediatric blunt intraabdominal arterial injury is ill defined. We analyzed a multiinstitutional trauma database to better define injury patterns and predictors of outcome.

METHODS

The American College of Surgeons National Trauma Database was evaluated for all patients younger than 16 years with blunt intraabdominal arterial injury from 2000 to 2004. Injury distribution, operative treatment, and variables associated with mortality were considered.

RESULTS

One hundred twelve intraabdominal arterial injuries were identified in 103 pediatric blunt trauma patients. Single arterial injury (92.2%) occurred most frequently: renal (36.9%), mesenteric (24.3%), and iliac (23.3%). Associated injuries were present in 96.1% of patients (abdominal visceral, 75.7%; major extraabdominal skeletal/visceral, 77.7%). Arterial control was obtained operatively (n = 46, 44.7%) or by endovascular means (n = 6, 5.8%) in 52 patients. Overall mortality was 15.5%. Increased mortality was associated with multiple arterial injuries (P = .049), intraabdominal venous injury (P = .011), head injury (P = .05), Glasgow Coma Score less than 8 (P < .001), cardiac arrest (P < .001), profound base deficit (P = .007), and poor performance on multiple injured outcomes scoring systems (Revised Trauma Score [P < .001], Injury Severity Score [P = .001], and TRISS [P = .002]).

CONCLUSION

Blunt intraabdominal arterial injury in children usually affects a single vessel. Associated injuries appear to be nearly universal. The high mortality rate is influenced by serious associated injuries and is reflected by overall injury severity scores.

[Non-operative management of a hepatic pseudoaneurysm and a biloma complicating a blunt abdominal trauma]

Hepatic artery pseudoaneurysm and bilioma are rare complications of blunt abdominal trauma in children. We report a case in an 11-year-old patient after a hepatic and splenic blunt trauma following a car accident. The initial evolution was simple with haemodynamic stability. On Day 12, a pseudoaneurysm was discovered on an abdominal magnetic resonance imaging whereas the patient presented a major pain syndrome and an icteric cholestase. Embolisation was realised a few hours later in emergency because of a haemorrhagic shock. On Day 26, an endoscopic retrograde cholangiopancreatography highlighted two bilary leaks: one extrahepatic, the other intrahepatic. The first one was treated with a stent and the second one needed three drains: two peritoneal and one in the biloma. The characteristic of this case relies on the association of two complications. It underlines the need of multidiscipline and non-operative management of pediatric blunt hepatic trauma.