PMC7264984_01
The retrieved metallic shrapnel from the abdominal cavity; 6 x 3 x 2 cm.
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A 6 cm x 3 cm x 2 cm shrapnel was found anterior to the first part of the duodenum (Fig. 1).
CECT Abdomen showing the Intra-Hepatic Pseudoaneurysm; IHPA, emerging from a branch of Left Hepatic Artery; LHA. The lower figure shows the IHPA surrounded by the hematoma (within the circle).
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On the third postoperative day and before shifting the patient to the operating theatre for packs removal, CT of the abdomen was done; showed a 3 cm x 1.8 cm IHPA of the left hepatic artery (Fig. 2).
Selective celiac angiography shows the IHPA.. LHA: left hepatic artery; CHA: common hepatic artery; GDA: gastroduodenal artery.
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Hepatic angiography confirmed the presence of the IHPA emerging from a side branch of the left hepatic artery (Fig. 3).
Post embolization celiac angiography shows complete exclusion of the IHPA by endo-coils.
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Microcoil embolization of both afferent and efferent loops of the aneurysm was done (Fig. 4).
TachoSil Sealant Patches adhered well to the underlying hepatic injury, the inlet of the shrapnel.
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There was mild oozing from the hepatic injury site, which was easily controlled with TachoSil  Fibrin Sealant Patches (Fig. 5).
CECT Abdomen shows extra luminal leak of oral contrast from stomach to large pocket with air- fluid level in the sub-hepatic region. In the lower figure, the Intrahepatic coils seen in place, with good enhancement of both lobes of the liver.
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A follow-up CT showed an extra luminal leak of the oral contrast from the stomach with a sizeable subhepatic collection, right-sided hydropneumothorax, and right lung collapse (Fig. 6).
CT Chest shows the well-formed right sided empyema.
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As the right-sided pleural effusion had transformed into a well-formed empyema, decortication was performed (Fig. 7).
CT chest & Abdomen show normal looking both lung and liver parenchyma with no evidence of recurrence of the IHPA.
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Follow up CT showed normal looking both lung and liver parenchyma with no evidence of recurrence of the IHPA (Fig. 8).
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CECT abdomen showed the IHPA, marked by dotted circle along with subcapsular hematoma.
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CT was done after resuscitation, showed a 24 cm x 13 cm x 8.2 cm heterogeneous subcapsular hepatic hematoma and a 1-cm IHPA (Fig. 9).
The pseudoaneurysm before embolization; upper figure, and after coils embolization; lower figure.
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The entry and exit points of the aneurysm were successfully embolized with two microcoils (Fig. 10).