PMC3878419_01
Enhanced CT on admission. Enhanced CT shows a deep liver laceration (Grade IV on the Organ Injury Scale of the American Association for Surgery of Trauma) without extravasation or pseudoaneurysm or arterioportal fistula formation.
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APF (Figure 1); hence, NOM without angiography was selected. After admission, the patient's hemodynamic state continued to be stable, and the volume of intra-abdominal hemorrhage evaluated on ultrasonography did not increase.
Follow-up CT performed 13 days after the injury. Enhanced CT reveals an arterioportal fistula in segment 8 of the liver with partial enhancement of the liver parenchyma in the early phase.
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APF in segment 8, without pseudoaneurysm formation (Figure 2). Although embolization was considered, the APF was not accompanied by portal dilatation suggestive of portal hypertension; therefore, severe observation was selected.
Follow-up CT performed on day 58. The size of the low-density area of the anterior segment of the liver is reduced, and the arterioportal fistula has disappeared.
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Consequently, spontaneous closure of APF was obtained on follow-up CT performed on day 58 after the injury (Figure 3).