# Successful Coil Embolization of Active Bleeding From a Replaced Left Hepatic Artery to the Left Gastric Artery Associated With a Traumatic Rupture of a Simple Hepatic Cyst Causing Hemodynamic Instability

## TL;DR

A rare case of a ruptured liver cyst causing severe bleeding was successfully treated with coil embolization in an elderly patient with a history of anticoagulation.

## Contribution

This case highlights a successful interventional radiology approach to managing a rare complication of polycystic liver disease.

## Key findings

- Coil embolization effectively controlled active bleeding from an aberrant hepatic artery in a patient with a ruptured hepatic cyst.
- The patient's hemodynamic instability was resolved through super-selective embolization despite anticoagulation and anomalous vasculature.
- This case expands the understanding of managing rare intra-abdominal hemorrhage in polycystic liver disease patients.

## Abstract

Intra-abdominal hemorrhage resulting from a ruptured, large hepatic cyst in a polycystic liver disease (PCLD) patient is rare and potentially fatal if not addressed promptly. Only a few isolated cases have previously been reported. The usual patient profile consists of elderly patients on anticoagulation, as is demonstrated in our case. Intra-hepatic cysts are broadly classified into congenital, traumatic, infectious, parasitic, and neoplastic. Congenital intra-hepatic cysts can consist of both simple and PCLD, as is outlined in our case. Simple cysts are usually asymptomatic, but occasionally they may achieve larger dimensions and lead to complications such as rupture, obstruction, infection, hemorrhage, and even portal hypertension.

We present an uncommon case of a 78-year-old patient with PCLD on rivaroxaban who presented initially with diffuse abdominal pain, distension, and progression into hemodynamic instability. A computerized tomography (CT) scan revealed a ruptured left hepatic lobe cyst, causing hemoperitoneum and resulting in an acute abdomen. This case was complicated by the patient’s anticoagulation status and anomalous hepatic vasculature pattern. Interventional radiology (IR) successfully identified the aberrant bleeding vessel and stopped the active extravasation with super-selective coil embolization.