Trauma-induced dual vascular lesions in the liver-hepatic pseudoaneurysm with arteriohepatic venous fistula

Description 

A 17-year-old boy presented to the emergency triage with severe abdominal pain following blunt abdominal trauma. The patient was conscious, hypotensive with blood pressure 60/30 mm Hg, pulse rate 110/min and per abdomen examination revealed abdominal distension, tenderness, rigidity and free fluid. FAST (Focused Assessment with Sonography in Trauma) imaging revealed liver lacerations and haemoperitoneum. The patient was initially stabilised with inotropes, intravenous fluids and adequate analgesics and had to be directly taken up for emergency laparotomy as the ideal protocol of performing an emergency CT was forgone due to technical issues with the CT machine. Laparotomy revealed grade V liver injury with active bleeding and haemoperitoneum of about 2 L. Haemostatic agent (AbGel) and multiple intra-abdominal packs were used to stop bleeding, and massive blood transfusion protocol was activated. The patient was transferred to intensive care unit where he improved with conservative treatment. Before removing the intra-abdominal packs by relaparotomy,...

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