A Case of Traumatic Liver Injury Complicated by a Large Hematoma Treated Conservatively

Abstract

The patient was a 10-year-old girl who sustained an abdominal injury from bicycle handlebar trauma. A contrast-enhanced CT scan revealed a large hepatic hematoma with contrast extravasation, prompting angiography. Active bleeding from the hepatic artery was detected, and transcatheter arterial embolization was performed to achieve hemostasis. On the third day of hospitalization, she showed worsening anemia and elevated liver enzymes, with ultrasound revealing an enlarging hematoma and ascites. A contrast-enhanced CT scan was performed again, but no contrast extravasation was observed, and the enhancement of the liver parenchyma was maintained. Therefore, the possibility of rebleeding and hepatic compartment syndrome was considered low. Her condition improved with blood transfusions and conservative treatment, and she was discharged on the 32nd day of hospitalization. During her hospitalization, the hematoma was monitored using ultrasound and contrast-enhanced CT. Temporal changes in the hematoma were observed, with plasma components being absorbed in the acute phase, followed by the gradual dissolution of blood cell components, leading to a reduction in size. Observing the temporal imaging changes of a large hematoma is considered helpful in determining the appropriate timing for invasive treatment, should it become necessary.