Traumatic Hepatic Artery Pseudoaneurysm with Hemobilia -A Report of Two Cases-

Masaki Nagaya, Sunao Kubota* and Katsuya Akashi

Department of Emergency and Critical Care Medicine, Department of General Surgery*, St. Marianna University School of Medicine

A traumatic hepatic artery pseudoaneurysm with hemobilia is a rare complication of hepatic trauma. The management of hemobilia has evolved with a changing strategy. Previously, a hemobilia was managed primarily by surgery, but today, it is managed by transcatheter arterial embolization (TAE) and this management has been accepted as the gold standard. Following this strategy, we selected TAE for two patients who suffered from hemobillia with JAST type Ib injury and hemostasis was accomplished complete by TAE, without any biloma or inflammation. Another patient, with JAST type IIIa injury with biloma and infection died from exsanguinations. Bile retards liver healing and will lyse clotted blood if the clot is bathed in bile. In the presence of bile, the clot of an arterial injury can lyse, forming a pseudoaneurysm.
We conclude that TAE can be accomplished in patient with none of biloma or inflammation. But hemostasis by TAE is impossible those in whom there is a large biloma cavity with systemic inflammation.

Key words
hemobilia, hepatic artery pseudoaneurysm, transcatheter arterial embolization

Reprint requests
Masaki Nagaya Department of Emergency Critical Care Medicine, St. Marianna University School of Medicine
2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511 Japan

Accepted
September 24, 2003

To read the PDF file you will need Abobe Reader installed on your computer.