Mesenteric Ischemia: An Unusual Presentation of Traumatic Intrahepatic Arterioportal Fistula

Abstract

Traumatic hepatic arterioportal fistulae (APF) are described infrequently as sequelae of hepatic trauma. These anomalies are usually associated with blunt hepatic trauma or iatrogenic injury. The majority of APF present within weeks to months of injury with gastrointestinal hemorrhage, hemobilia, abdominal pain, and diarrhea. When presenting remotely APFs are associated with portal hypertension, heart failure, gastrointestinal hemorrhage, ascites, and splenomegaly. We report an unusual case of mesenteric ischemia due to an APF that resulted from a penetrating liver injury 20 years before presentation. Successful treatment of the APF was achieved by intravascular catheter occlusion resulting in resolution of symptoms.

The Congenital Intrahepatic Arterioportal Fistula Syndrome

“…Less than 10% of all arterioportal fistulae that involve the hepatic artery are congenital (1). Secondary causes of IAPF are more common and well described, including major blunt (7,8) or penetrating (9‐11) abdominal trauma, surgical procedures such as needle liver biopsy (12‐14), Kasai portoenterostomy (15‐17) and segmental liver transplantation (18), hepatic artery aneurysm (14,19), cirrhosis (20‐22), hepatocellular carcinoma (23‐25), biliary atresia (26) and hereditary hemorrhagic telangiectasia (27‐30).…”