CASE 2 – Embolization Liver Lesion
68yo male 12 p.o. day after Whipple procedure. Sent home (9lh p.o. day) with anticoagulation and antiplatelet thx (previous ischemic heart dis.) Came back to ER with abd pain and reduction in Hb levels after minor trauma at home. CT reveals hematoma w active bleeding from liver parenchyma in S5. ANGIO identifies bleeding site from peripheral branch or intermediate hepatic artery. Treated by glue (1:5)
In this case, I used glue, which took me about 2 minutes, so the procedure was much quicker. Additionally, the patient was under anticoagulation and the glue works regardless of the coagulation profile of the patient. This is a very interesting issue as, sometimes, the bleeding is in fact due to the anticoagulation itself. So, we have a product that not only is extremely rapid and effective but also does not revascularize. To answer a previous question, sometimes gelfoam is not ideal: it takes time and does not ensure stability.
The SPLEEN is not a setting where embolization has been used extensively. Proximal embolization is the accepted way but, when stopping the bleeding takes time, we can use the glue within the coils. We need to be extremely careful, though, as the following case reports will show. These are not specifically trauma cases, but they will nonetheless elucidate what I am trying to say.