TRAUMATIC HEPATIC-ARTERY PSEUDOANEURYSM WITH HEMOBILIA

Hepatic artery pseudoaneurysm (HPA) with hemobilia is an Imusual compl ication of hepatic trauma. Initial operative management can have an im pact on the development of HPA, and definitive management is difficult . A total of 482 consecutive patients with liver injury were prospecti vely analyzed. Six of these (1.2%) developed HPA with hemobilia. Three patients developed HPA after penetrating injuries, and 3 after blunt trauma. All 6 patients had hemobilia with massive upper gastrointestin al hemorrhage; HPA was confirmed by angiography. A total of 80% had bi le leaks as revealed by hepatobiliary scans. One patient was nonseptic and had a small intrahepatic cavity, and the patient underwent succes sful embolization of the HPA. The remaining 5 had unexplained sepsis w ith large intrahepatic cavities and underwent operation. Two died due to massive blood loss and coagulopathy during attempted cavity debride ment prior to gaining vascular control. One had right hepatic artery l igation in lieu of resection and subsequent lobectomy after recurrence of hemobilia; the other 2 had formal hepatic resections. No survivors had further rebleeding. We conclude that (1) HPA with hemobilia is pr edisposed by bile leak; (2) embolization appears appropriate for patie nts with small cavities without sepsis; and (3) debridement and draina ge, which may require formal resection, are necessary for those with l arge cavities and/or sepsis after vascular control is obtained either by preoperative embolization or intraoperatively.