Transcatheter arterial embolization for hemoperitoneum: unusual manifestation of iatrogenic injury to abdominal muscular arteries.
OBJECTIVE
To evaluate the etiology of unusual manifestation of hemoperitoneum and the efficacy of transcatheter arterial embolization (TAE).


METHODS
A retrospective review of patients at three hospitals was performed. A total of 12 patients (M:F = 5:7, mean age: 48) had massive hemoperitoneum without evidence of an intramuscular hematoma on CT (n = 10) or US (n = 2) after injury to the abdominal wall. The patients underwent TAE. The etiology of iatrogenic injury to the abdominal muscular arteries and the effectiveness of embolization were evaluated.


RESULTS
Among 12 patients, 11 patients had injuries to the inferior epigastric artery (IEA) and one patient had an injury to the deep circumflex iliac artery (DCIA). The causes of the injuries were: paracentesis (n = 6), open laparotomy (n = 4), removal of a CAPD catheter (n = 1), and surgical drain (n = 1). The TAE was successfully performed in all patients. Over 10 days of follow-up after the embolization, all patients were stabilized hemodynamically.


CONCLUSIONS
Injury to the IEA or DCIA should be considered as a possible source of hemoperitoneum even in patients with no evidence of an intramuscular hematoma after injury to the superficial arteries of the abdominal wall. In addition, such injuries can be treated successfully using TAE.
Department of Radiology, Research Institute of Medical Science, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea, psw0224@kuh.ac.kr
Sang Woo
SW
Park
Su Yeon
SY
Ko
So Young
SY
Yoon
Won Hyeok
WH
Choe
Ik Jin
IJ
Yun
Seong-Hwan
SH
Chang
Jong Yun
JY
Won
Hwan Hoon
HH
Chung
D000009:Abdominal Muscles / Q000098:blood supply* / Q000000981:diagnostic imaging; D034861:Abdominal Wall / Q000000981:diagnostic imaging; D003287:Contrast Media; D020878:Device Removal / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004322:Drainage / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000379:methods*; D019074:Epigastric Arteries / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006465:Hemoperitoneum / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007049:Iatrogenic Disease; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
D003287:Contrast Media