A man in his 40s, injured when he fell off a roller coaster, underwent emergent hepatorrhaphy and gauze packing for a large crush injury of the right hepatic lobe with extravasation and intraabdominal bleeding. The postoperative course was uneventful, but black stool was observed on day 21; upper gastrointestinal tract endoscopy revealed no abnormality, including in the papilla of Vater. A trend towards improvement of bloody stool was observed; therefore, conservative treatment was continued. However, as large amounts of black stool and severe right hypochondriac pain occurred on day 25, abdominal dynamic CT was performed, which revealed a round tumorous shadow of uniform density about 20 mm in diameter, with a clear boundary, in the damaged region of the anterior segment of the right hepatic lobe, suspected to be caused by a ruptured hepatic artery pseudoaneurysm into the biliary tract. Angiography revealed that the A5/A8 branching region of the right hepatic artery anterior segment branch fed into the aneurysm, and gelatin sponge injection and parent artery coil embolization of A8, A5 and the right hepatic artery anterior segment branch were performed, which led to effectively controlled the bleeding. Thus, the possibility of ruptured hepatic artery pseudoaneurysm must be considered in cases of gastrointestinal bleeding after hepatic injuries, and a system should be established for transcatheter arterial embolization (TAE) to be performed quickly when necessary.
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