Hepatic necrosis and dysfunction following angioembolization in a trauma-related mortality

Angiographic embolization is a key tool in managing hemorrhage from blunt traumatic injuries, particularly hepatic trauma, but it carries risks such as hepatic necrosis. The incidence of clinically significant hepatic necrosis post-embolization is around 6%, with non-selective embolization increasing this risk compared to selective techniques. To report a case of a patient with high-grade blunt hepatic injury who developed hepatic necrosis and dysfunction leading to death following non-selective angiographic embolization. A 46-year-old male involved in a high-speed motor vehicle collision underwent emergency laparotomy for multiple liver lacerations, followed by non-selective coil embolization of the right and middle hepatic artery trunks due to suspected ongoing hemorrhage. The case was retrospectively analyzed, including operative findings, imaging (CT and angiography), and clinical outcomes over 25 days. Despite no active contrast blush on CT or angiography, non-selective embolization was performed. The patient developed patchy hepatic necrosis, requiring multiple laparotomies, and progressed to liver failure, ARDS, and cerebral edema. Death occurred 25 days post-admission due to severe encephalopathy, with hepatic necrosis likely exacerbated by the embolization. This case suggests that non-selective angiographic embolization may have contributed significantly to hepatic necrosis and mortality in a patient with high-grade hepatic trauma, highlighting the need for careful consideration of embolization indications and techniques.