Li Xiaohui, Zhao Ningbo, Zhong Lin, Zhang Yu, Luo Yongfang
Department of Ultrasound, National Clinical Research Centre for Infectious Disease, Shenzhen Third People's Hospital and the Second Hospital Affiliated with the Southern University of Science and Technology, Shenzhen, Guangdong, China.
Department of Liver Surgery, National Clinical Research Centre for Infectious Disease, The Third People's Hospital of Shenzhen and the Second Hospital Affiliated with the Southern University of Science and Technology, Shenzhen, Guangdong, China.
Am J Case Rep. 2025 Jun 4;26:e947297. doi: 10.12659/AJCR.947297.
BACKGROUND Injury to the inferior epigastric artery is a major complication of abdominal puncture, and continuous active bleeding from this artery can lead to hemorrhagic shock. Several studies have reported the use of contrast-enhanced ultrasound (CEUS) to diagnose active bleeding in parenchymal organs. Fluid gelatin is a new hemostatic material that can be injected into the bleeding site by using a puncture needle under the precise guidance of CEUS, which enables the implementation of local minimally invasive and appropriate hemostatic treatment. Here, we report the case of a patient in whom CEUS was used to accurately locate the bleeding site before surgery and guide local injection of fluid gelatin with a puncture needle to successfully achieve nonsurgical treatment of hemostasis. CASE REPORT A 62-year-old man with post-hepatitis B cirrhosis underwent a successful liver transplant surgery. After surgery, abdominal puncture and drainage were performed because of a large amount of peritoneal effusion due to nephrotic syndrome. The drainage fluid was bright red bloody liquid. CEUS revealed many contrast agent microbubbles extravasating from the inferior epigastric artery into peritoneal effusion along the abdominal puncture tract. Surgical suturing and applying a compression bandage failed to achieve satisfactory results. After receiving the patient's consent, thrombin and hemostatic glue were injected locally under the guidance of CEUS. Finally, hemostasis was successfully achieved. CONCLUSIONS CEUS-guided injection of fluid gelatin is a safe and effective treatment method and could serve as an effective measure for nonsurgical treatment and postoperative supplementary treatment of active bleeding from the inferior epigastric artery.
腹壁下动脉损伤是腹部穿刺的主要并发症，该动脉持续活动性出血可导致失血性休克。多项研究报道了使用超声造影（CEUS）诊断实质器官的活动性出血。液体明胶是一种新型止血材料，可在CEUS精确引导下通过穿刺针注入出血部位，从而实现局部微创且恰当的止血治疗。在此，我们报告1例患者，术前使用CEUS准确定位出血部位，并引导穿刺针局部注射液体明胶，成功实现了非手术止血治疗。病例报告：一名62岁的乙肝后肝硬化男性患者成功接受了肝移植手术。术后，因肾病综合征导致大量腹腔积液而进行了腹腔穿刺引流。引流液为鲜红色血性液体。CEUS显示许多造影剂微泡沿腹腔穿刺通道从腹壁下动脉渗入腹腔积液。手术缝合及应用压迫绷带未能取得满意效果。在获得患者同意后，在CEUS引导下局部注射了凝血酶和止血胶。最终成功实现止血。结论：CEUS引导下注射液体明胶是一种安全有效的治疗方法，可作为腹壁下动脉活动性出血非手术治疗及术后补充治疗的有效措施。
