A CASE OF SEVERE HEPATIC INJURY WITH REBLEEDING FROM AN N-BUTYL-2-CYANOACRYLATE EMBOLIZED SITE AFTER UNPACKING

Abstract

　　A 50-year-old man who was in a car accident presented with symptoms of shock. Ultrasonography revealed intraabdominal hemorrhage. Emergency laparotomy was performed to achieve hemostasis. Direct suture and perihepatic packing were performed for a deep laceration in the right lobe of the liver. Then, the anterior branch of the right hepatic artery was embolized with n-butyl-2-cyanoacrylate (NBCA). Although hemostasis was achieved after the two-stage surgery, shock reoccurred 12 hours later. Rebleeding from the embolized site required repeated maintenance of hemostasis. NBCA exerts a reliable embolic effect even in patients with coagulopathies. One of the possible causes of rebleeding was that the sclerosing substances molded in the liver that were deformed by packing may not have fit the hepatic blood vessel after the packs were removed. Even after achieving hemostasis with NBCA, the likelihood of rebleeding should be considered after removal of the packs.