Abstract
A 48-year-old man was admitted to our hospital complaining of epigastric pain after falling up some stairs. Abdominal CT revealed a type IIIb hepatic injury. Because the patient was hemodynamically stable, we chose conservative treatment. Follow-up CT at 2 weeks after the accident demonstrated a hepatic pseudoaneurysm with an arterioportal shunt. Transarterial embolization (TAE) was attempted initially but was switched to laparotomy because the shunt flow was very fast and there was a danger of causing wide embolization of the portal vein through the shunt. We performed ligation of S5b+c Glisson under ultrasound (US) monitoring of blood flow in the pseudoaneurysm (US-guided) because the patient was a heavy drinker and we were hesitant to perform extensive hepatectomy. At 16 days after the operation, the pseudoaneurysm had reformed through the collateral arteries and we performed TAE of the middle hepatic and A8 arteries. TAE could be performed safely because S5b+c Glisson was already ligated. US-guided selective ligation of Glisson's capsule is considered a relatively simple and minimally invasive method that offers effective management of hepatic aneurysms following blunt liver injury.
