Abstract
A 21-year-old man who had suffered a bruise on the left breast and the right back was carried from another hospital to our hospital by ambulance, because he had traumatic blunt hepatic and renal injury diagnosed by CT. We found an increase of hematoma in several hours on CT, but his vital signs and laboratory data did not worsen and we chose a conservative therapy. On the third hospital day, he had an acute growth of subcapsular hematoma and suffered hepatic and renal failure. Findings by angiography using iodinated contrast material suggested arterioportal shunt (AP shunt). However, we could not detect active bleeding points and we chose conservative therapy again such as a blood transfusion and continuous hemodiafiltration (CHDF), not transcatheter arterial embolization (TAE). As a result, his condition recovered gradually. In patients suffering from subcapsular hematoma by traumatic hepatic injury, hepatic failure caused by an growth of hematoma or treatment of TAE is rare. However, we consider that perhaps in this case we could have prevented the increase of subcapsular hematoma by earlier angiography and interventional radiology (IVR) including carbon dioxide intraarterial digital subtraction angiography (CO2-IADSA).
