Hassine Hiba Ben, Tayeb Ahmed Hadj, Jalleli Maissa, Jabra Sadek Ben, Saad Jamel, Noomen Faouzi
Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia.
Department of Radiology, Fattouma Bourguiba Hospital, Monastir, Tunisia.
Radiol Case Rep. 2025 Mar 9;20(5):2615-2618. doi: 10.1016/j.radcr.2025.01.050. eCollection 2025 May.
Pseudoaneurysm of the hepatic artery, first described by Sandblom in 1948, is an uncommon complication of hepatic trauma. Since then, numerous cases have been documented. Post-traumatic hepatic pseudoaneurysm of the hepatic artery is a rare complication, occurring in approximately 1.2% of patients with traumatic liver injury. We report the case of a 25-year-old patient with a history of Behçet's disease, treated with colchicine, who sustained a traffic accident resulting in hepatic contusion and rib fractures. The patient developed right hypochondriac pain, jaundice, and gastrointestinal hemorrhage, consistent with Quincke's triad, suggesting pseudoaneurysm rupture. The diagnosis was confirmed by computed tomography (CT), and the patient underwent successful percutaneous embolization. Despite established guidelines for managing blunt abdominal trauma, the approach to post-traumatic hepatic pseudoaneurysm remains controversial. While some advocate for prophylactic angiographic embolization to prevent bleeding, others favor conservative management due to the potential for spontaneous resolution. Currently, minimally invasive percutaneous embolization is the primary treatment modality. In cases where embolization fails, a transhepatic approach may serve as an alternative. The angioscan is a reliable diagnostic tool. Management is now predominantly minimally invasive, guided by radiological imaging. When conventional angiographic treatment fails, the transhepatic approach can be considered.
肝动脉假性动脉瘤由桑德布洛姆于1948年首次描述，是肝外伤的一种罕见并发症。自那时以来，已有大量病例记录在案。创伤后肝动脉假性动脉瘤是一种罕见的并发症，约1.2%的肝外伤患者会出现。我们报告一例25岁患有白塞病且正在接受秋水仙碱治疗的患者，该患者遭遇交通事故，导致肝挫伤和肋骨骨折。患者出现右季肋部疼痛、黄疸和胃肠道出血，符合昆克三联征，提示假性动脉瘤破裂。通过计算机断层扫描（CT）确诊，患者接受了成功的经皮栓塞治疗。尽管有处理钝性腹部创伤的既定指南，但创伤后肝假性动脉瘤的治疗方法仍存在争议。一些人主张进行预防性血管造影栓塞以防止出血，而另一些人则因可能自发缓解而倾向于保守治疗。目前，微创经皮栓塞是主要的治疗方式。在栓塞失败的情况下，经肝途径可作为一种替代方法。血管扫描是一种可靠的诊断工具。目前治疗主要以微创为主，由放射影像学引导。当传统血管造影治疗失败时，可考虑经肝途径。
