Salvage embolization after surgery failure in hemodynamically unstable severe-grade liver trauma

The liver is commonly injured after blunt abdominal trauma. The choice of treatment for liver trauma depends not only on injury severity but also on the patient’s hemodynamic status. Most minor- and moderate-grade liver injuries in hemodynamically stable patients allow for conservative treatment or minimal intervention, while emergency laparotomy is indicated for patients with severe-grade liver trauma and hypotensive shock. We describe a 19-year-old male patient with traumatic shock due to grade IV liver injury and multiple fractures. An emergency laparotomy was performed, but the bleeding could not be controlled, and the patient remained hemodynamically unstable. Hyperacute transarterial embolization was successfully performed. In this case report, we emphasize the importance of transarterial embolization in cases of residual bleeding after initial damage-control surgery, even in hemodynamically unstable patients.