Liver Embolization for Blunt Trauma

Middle aged John Doe brought to the Emergency Room after a motor vehicle accident. Imaging demonstrated hepatic lacerations. The patient was taken to the OR for control of bleeding. Surgical packing was unable to control the hemorrhage. Embolization was requested.
The above two images are from an angiographic run from the proper hepatic artery in the frontal projection. There are two distinct areas of extravasation (arrows and arrowheads).

Embolization of lower area of extravasation was unsuccessful with gelfoam. Four straight coils (arrows in the left image) were deployed with successful embolization. The upper area was successfully embolized with gelfoam alone. The right image is a completion angiogram. When control of hemorrage is difficult distally, a more proximal embolization may be indicated. Subsequently in the patient's hospital course, upper endoscopy reported finding gelfoam particles in the bile ducts.