That is the case of patient Vo Thi Th (69 years old, from Gia Lai province). Patient Th was admitted to the hospital on December 28, 2022 with symptoms of high fever, right upper quadrant pain, and was diagnosed with a hepatobiliary abscess. CT scan of the abdomen on admission showed a liver abscess and a pseudoaneurysm mass in the right liver.
During the treatment, the patient had no fever and no pain in the right upper quadrant. However, on the 10th day of hospital stay, the patient had black stools, and the red blood cell test was severely reduced. The patient was transfused with red blood cells, for gastroscopy, only mild scratch inflammation was detected.
Patient Vo Thi Th during treatment at Hue Central Hospital. Photo: Nhat Tan.
On the 15th day, the patient suddenly developed blood loss with rapid pulse, low blood pressure, pale eye mucosa, continued black stools, blood tests showed a severe decrease in red blood cells. The patient was urgently intensively resuscitated and blood transfusion, inter-departmental consultation with the Department of Diagnostic Imaging, Department of Endoscopy.
The patient was diagnosed and monitored for hemorrhagic shock due to the rupture of a pseudoaneurysm of the hepatic artery due to a liver abscess. When the patient’s shock condition was stable, the patient underwent a CT scan of the abdomen and endoscopic examination of the bile flow through the vater bulb. The results confirmed that the patient had a pseudoaneurysm rupture of the hepatic artery. The patient received intensive, urgent resuscitation and emergency percutaneous selective hepatic artery embolization.
Doctor CCII Le Duy Cat and his team of radiologists successfully performed embolization. The patient was followed up closely for 48 hours and then showed no more bleeding and yellow stools. The patient was discharged on January 17, 2023.
According to Assoc. Prof. Ho Huu Thien, Deputy Head of Department of Pediatric Surgery – Abdominal Emergency, Hue Central Hospital, pseudoaneurysmization of hepatic artery due to liver abscess is very rare, if not detected and treated promptly, the patient will be shocked due to blood loss and lead to death. The clinical presentation is hemorrhagic shock due to massive bleeding into the biliary tract or peritoneal cavity. Patients may have melena due to blood inflow into the biliary tract or abdominal distension due to blood flow into the peritoneal cavity.
Professor Pham Nhu Hiep, Director of Hue Central Hospital said: The patient appeared to be bleeding due to the rupture of a pseudobulb of the hepatic artery due to a liver abscess and needed intensive resuscitation and resolution of the ruptured hepatic aneurysm. Endovascular embolization is the first-line treatment with a success rate of 95%. This case was successfully managed by percutaneous endovascular embolization. The relationship between hepatic pseudoaneurysm and liver abscess must not be ignored, bearing in mind that aneurysm rupture is potentially fatal and can be prevented by timely percutaneous embolization.
