Hasegawa Satoshi, Moriwaki Yoshihiro, Uchida Keiji, Kosuge Takayuki, Yamamoto Toshiro, Sugiyama Mitsugi
Critical Care and Emergency Unit, Yokohama City University, School of Medicine, Yokohama, Japan.
Hepatogastroenterology. 2004 Mar-Apr;51(56):434-5.
Post-traumatic hepatic pseudoaneurysms are rare. We report a very unusual case of bile duct injury complicated with an asymptomatic post-traumatic hepatic pseudoaneurysm. A previously healthy 17-year-old man sustained multiple traumas after a motorcycle accident. Post-traumatic hepatic pseudoaneurysms were detected after blunt liver injury. The rapid growth of the pseudoaneurysms in the hepatic hilus compressed the common hepatic bile duct and caused extrahepatic bile leakage at the lateral lobe. At first, the hepatic arterial pseudoaneurysms were embolized and bile leakage at the left lobe was treated conservatively. Finally, however, segment 2 and 3 partial liver resection should have been performed to stop the bile leakage. Post-traumatic pseudoaneurysm should be ruled out, in addition to the presence of biliary tract injury, if the intraperitoneal bile leakage appears after liver injury.
创伤后肝假性动脉瘤较为罕见。我们报告了一例非常特殊的病例,即胆管损伤并发无症状创伤后肝假性动脉瘤。一名既往健康的17岁男性在摩托车事故后遭受多处创伤。钝性肝损伤后检测到创伤后肝假性动脉瘤。肝门处假性动脉瘤的快速生长压迫了肝总管,导致外侧叶肝外胆汁漏出。起初,对肝动脉假性动脉瘤进行了栓塞,并对左叶胆汁漏进行了保守治疗。然而,最终应进行2段和3段部分肝切除术以阻止胆汁漏出。如果肝损伤后出现腹腔胆汁漏,除了存在胆道损伤外,还应排除创伤后假性动脉瘤。