Emergent transcatheter embolization of massive hepatic hemorrhage

Seven cases of blunt trauma to the abdomen are reported with significant hepatic vascular injury, hemoperitoneum, and hypotensive shock. Six patients were involved in motor vehicle accidents, and one patient was assaulted. By computed tomographic imaging, the liver injuries were all grade 3–4, according to the Mirvis classification system (Mirvis SE, et al. Radiology 1989;171:27–32). All seven patients underwent angiography with the identification of an active bleeding site(s). Embolization was performed with Gelfoam pledgets, steel coils, polyvinyl alcohol particles, or a combination of materials. In all seven cases, technical success was achieved, with control of hemorrhage and stabilization of the patient’s shock. One patient later succumbed to multiorgan failure. One patient required a second embolization for hemorrhage at a second site. Transcatheter embolization is an effective method for the control of life-threatening hepatic hemorrhage secondary to blunt abdominal trauma.