Spontaneous Resolution of Post-Traumatic Hepatic Artery Pseudoaneurysm Presenting as Hemobilia, Hemocholecystitis and Shock

Abstract

Background: Post-traumatic hepatic artery pseudoaneurysm is a rare, but life threatening condition. Symptoms can occur days or even months after the trauma. Case Summary: A 12-year-old child was presented to us with complaints of hematemesis, melena and severe right hypochondrium colicky pain for last 2 days. He had a history of blunt abdominal trauma (accidental fall from height) 1-month back requiring admission in outside hospital. At the time of admission to us, the child was hemodynamically unstable. CECT abdomen showed a focal area (14 × 8 mm) of staining in arterial phase was seen in segment 5, suggestive of pseudoaneurysm of right hepatic artery branch. CT angiography confirmed the presence of pseudoaneurysm. He was resuscitated and after hemodynamic stabilization, our interventional cardiology team planned angiographic embolization of pseudoaneurysm. On 3rd day of admission, child developed chicken pox and procedure was deferred for sometime. Repeat CECT Abdomen with CT Angiography (done 10 days after admission and approx 6 wks after trauma) showed complete resolution of pseudoaneurysm. Child was discharged 2 weeks after presentation with significant improvement in liver function tests. The child remained asymptomatic for the next 6 months in follow up. Conclusion: Spontaneous resolution of post-traumatic pseudoaneurysm can occur even in hemodynamically unstable and symptomatic cases (Figure 1). The authors have none to declare.