Delayed hepatic artery pseudoaneurysm with arterioportal fistula after penetrating liver trauma successfully treated with coil embolization: a case report and focused literature review.

Hepatic artery pseudoaneurysm (HAP) with arterioportal fistula (APF) is a rare but potentially life-threatening vascular complication of hepatic trauma, most commonly described after blunt or iatrogenic injury and infrequently following penetrating trauma. Early identification and prompt endovascular management are essential to prevent severe outcomes. We report the case of a 25-year-old previously healthy male who sustained a stab wound to the right upper quadrant and epigastrium and underwent exploratory laparotomy for a grade III left hepatic lobe laceration. During postoperative recovery, he developed persistent blood-tinged drain output and epigastric pain. Contrast-enhanced CT and subsequent angiography confirmed a left hepatic artery pseudoaneurysm with an associated arterioportal fistula. Initial Gelfoam embolization failed, but definitive coil embolization via the femoral artery successfully excluded the lesion and resolved the fistulous communication. The patient experienced symptomatic improvement and was discharged in stable condition. This case underscores the importance of recognizing delayed vascular complications following penetrating liver trauma and highlights endovascular coil embolization as a safe and effective therapeutic approach. Structured postoperative follow-up remains crucial for optimal outcomes.