Abdominal Hematoma

Omar Chohan, DO

Vascular Interventional Radiologist

Gates Vascular Institute

A 91-year-old male with a past medical history of COPD, CAD, dementia, and DVT on Eliquis presented to the ED for severe abdominal pain and a large bruise over his left anterior abdominal wall.
An abdominal and pelvic CT with contrast showed a large anterior abdominal wall rectus sheath hematoma with active extravasation.
Conservative measures failed to control his symptoms.
The embolization technique utilized a gelfoam slurry to target tiny distal vessels and to ensure distal hemostasis.
Proximally, a permanent occlusion was necessary to prevent recurrent bleeds. The flexibility of the LOBO-3 occluder enabled smooth delivery through the tortuosity of a reverse curve catheter and a 2.8mm left inferior epigastric artery.
Deployment was precise and stable without migration; LOBO-3 provided rapid and complete occlusion of the target artery with a single device.
The patient remained bleed free during hospitalization and left the hospital 3 days following the embolization procedure.

Figure 1: Contrast enhanced CT of the pelvis shows large anterior abdominal wall rectus sheath hematoma with active extravasation (arrows).

Figure 2: Selective angiogram of the left inferior epigastric artery revealing patent vessel with no active extravasation within the distal or proximal branches.

Figure 3: Spot image demonstrates a microcatheter within the proximal left inferior epigastric artery. Delivery of LOBO-3 can be seen via the proximal and distal radiopaque markers (arrows).

Figure 4: Selective post embolization angiogram revealing complete occlusion of the left inferior epigastric artery following deployment of the LOBO-3 (arrows).

Figure 5: Contrast enhanced CT post embolization shows large anterior abdominal wall rectus sheath hematoma (single arrow) without active extravasation.

Figure 6: LOBO-3 (double arrows) within the left inferior epigastric artery.

The LOBO occluder provides for smooth trackability and delivery in a tortuous environment. Placement of a single device resulted in rapid and accurate target vessel occlusion without migration. The device generates minimal CT artifact which is of benefit during follow-up imaging.