Abstract
IntroductionHepatic pseudoaneurysm (HPA) is a rare complication after liver trauma, yet it is potentially fatal, as it can lead to sudden severe haemorrhage. The risk of developing posttraumatic HPA is one of the arguments for performing follow-up CT of patients with liver injuries. The aim of this study was to investigate the occurrence of HPA post liver trauma.MethodsA retrospective study from 2000-2010 of conservatively treated patients with blunt liver trauma was performed to investigate the incidence and nature of HPA. After the initial CT scan patients were admitted to the department and if not clinically indicated prior a follow-up CT was performed on day 4-5.ResultsA total of 259 non-operatively managed patients with liver injury were reviewed. 188 had a follow-up CT or US and in 7 patients a HPA was diagnosed. All aneurysms were treated with angiographic embolization and there were no treatment failures. There was no correlation between the severity of the liver injury and development of HPA. 5 out of 7 patients were asymptomatic and would have been discharged without treatment if the protocol did not include a default follow-up CT.ConclusionsIn conclusion, this study shows that HPA is not correlated to the severity of liver injury and it develops in 4% of patients after traumatic liver injury. In order to avoid potentially life-threatening haemorrhage from a post trauma hepatic pseudoaneurysm, it seems appropriate to do follow-up CT as part of the conservative management of blunt and penetrating liver injuries.
Highlights
Hepatic pseudoaneurysm (HPA) is a rare complication after liver trauma, yet it is potentially fatal, as it can lead to sudden severe haemorrhage
A pseudoaneurysm is a false aneurysm that develops from a leakage of an injured artery into the surrounding tissues forming a cavity outside the artery
The diagnosis of an HPA is made with either arteriography, contrast-enhanced computer tomography (CTangiography) or Doppler Ultrasound (US) [5]
Summary
Hepatic pseudoaneurysm (HPA) is a rare complication after liver trauma, yet it is potentially fatal, as it can lead to sudden severe haemorrhage. The risk of developing posttraumatic HPA is one of the arguments for performing follow-up CT of patients with liver injuries. A hepatic pseudoaneurysm (HPA) is an unusual but potentially lethal complication after blunt or penetrating liver injury [1,2,3,4]. A pseudoaneurysm is a false aneurysm that develops from a leakage of an injured artery into the surrounding tissues forming a cavity outside the artery. It can be distinguished from a haematoma as it continues to communicate with the artery resulting in a high-pressure cavity with the risk of rupture [5]. Development of a HPA is mainly described in patients after liver trauma but is reported after hepatobiliary surgery, pancreatitis, gallstone disease and liverrelated invasive procedures such as liver biopsies [5,7,8,9].
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