Selective surgical ligation for post-traumatic arterio-biliary fistula

Blunt abdominal trauma is a rare cause of intra-hepatic arterio-biliary fistula and pseudo-aneurysm. Surgery often indicated in cases that fail transcatheter arterial embolization (TAE). In this report we present a case of post-traumatic arterio-biliary fistula with intra-hepatic pseudo-aneurysm in a 10-year-old female patient. She presented with two episodes of massive hematemesis/melena and severe colicky epigastric pain of 5 days duration. Following informed consent from guardians, intra-operative ultrasound-guided selective clamping and ligation of liver segment 4 arterial and portal branches was performed. In conclusion, blunt abdominal trauma to liver can results in life-threatening arterio-biliary fistula and/or peudo-aneurysm. Selective ligation of pseudo-aneurysm feeders under intra-operative ultrasound guidance is recommended in resource-limited settings when interventional radiology is not available.