PMC5530444_01
(a) MD-CT axial view demonstrates the presence of a haematoma into the right rectus sheath (*) with two spots of active bleeding from distal collaterals of the right inferior epigastric artery (arrowheads). (b) MD-CT coronal Volume Rendering Technique image with right inferior epigastric artery reconstruction (arrowhead) and the haematoma into the right rectus sheath as a red shadow.
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She underwent urgent MultiDetector Computed Tomography (MD-CT) that demonstrated a 12 x 9 cm right rectus sheath haematoma extending into the pelvis with two active contrast extravasation (Figures 1(a) and 1(b)).
(a) Selective right iliac angiography confirmed the two spots of active bleeding (arrows) from distal collaterals of the right epigastric artery (arrowhead). (b) Fluoroscopic control with the right epigastric artery (arrowhead) filled by Squidperi 18 liquid embolic material. (c) Final selective right iliac angiography that confirms the embolization of the right epigastric artery (arrowhead) filled by Squidperi 18 liquid embolic material as a grey shadow.
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Angiography (Figure 2(a)) that confirmed the two spots of active bleeding from distal collaterals of the right epigastric artery. After coaxial superselective catheterization of the right epigastric artery with Terumo Progreat microcatheter 2.7 Fr (Terumo, Tokyo, Japan) and a previous shaking for at least 15 minutes of the liquid embolic device Squidperi 18 (Emboflu, Switzerland), the two types of active bleeding and the right epigastric artery were embolized (Figure 2(b)). The final DSA control confirms the complete embolization of the right epigastric artery (arrowhead) with absence of active bleeding (Figure 2(c)).
(a) MD-CT axial view at one month demonstrates the reduction of the haematoma into the right rectus sheath (*) with two hyperdense artefact due to the Squidperi liquid embolic material. (b) MD-CT coronal Volume Rendering Technique image at three months with right epigastric artery reconstruction (arrowhead) filed by Squidperi 18 liquid embolic material.
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Early follow-up at 3 months after embolization (including clinical observation, assessment of abdominal symptoms, and MD-CT) demonstrated no clinical complications, reduction of the haematoma into the right rectus sheath, and persistence as hyperdense image referred to Squidperi liquid embolic material (Figures 3(a) and 3(b)).