Severe gastrointestinal tract bleeding in a two-month-old infant due to congenital intrahepatic arterioportal fistula

Aarts, R A H M; IJland, Marloes M.; Blaauw, Ivo de; Hoogeveen, Yvonne L.; Boetes, C.; Proosdij, M. van

doi:10.1016/j.ejrad.2006.03.014

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…Congenital causes include Osler-Weber-Rendau and Ehlers-Danlos syndromes, arteriovenous fistula, and aneurysm [2][3][4] or neoplasm, such as hepatocellular carcinoma. 5 Acquired causes include neoplasm, aneurysm, trauma (both blunt and penetrating), as well as iatrogenic, such as from liver biopsy.…”

Section: Discussionmentioning

confidence: 99%

Hepatoportal Fistula in an 83-Year-Old Male, Presenting With Hematemesis 52 Years After Blunt Trauma

Blecher

Bohmer

2013

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Hepatoportal arteriovenous fistulae are a rare cause of portal hypertension, which can have significant clinical manifestations. They have multiple etiologies, one of which includes hepatic trauma. We present a case of hepatoportal fistula presenting with bleeding esophageal varices in an 83-year-old man. The exact cause of fistula in this case is not entirely clear; however, hepatic trauma was noted in the patients' history, some 52 years before presentation. We also present a literature review on this rare and interesting phenomenon.

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Section: Discussionmentioning

confidence: 99%

Hepatoportal Fistula in an 83-Year-Old Male, Presenting With Hematemesis 52 Years After Blunt Trauma

Blecher

Bohmer

2013

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…The increased blood flow in the portal system is considered to be the cause of portal hypertension 7,9,28. The increased portal pressure also impairs blood efflux from the spleen and gastrointestinal tract by increasing vascular outflow resistance, which may lead to potential complications 3,4. Mild to moderate abdominal pain and diarrhea secondary to congestive vascular enteropathy may be some early findings.…”

Section: Discussionmentioning

confidence: 99%

Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance

Meng¹,

Yang²,

Fu³

et al. 2012

Radiology and Oncology

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BackgroundTo evaluate the usefulness of the routine sonographic evaluation of the pattern of fluctuate portal velocity tracings and the hepatic veins for the diagnosis of arterioportal fistula (APF) and cardiogenic trans-sinusoidal shunting (CTS).Materials and methods.Color Doppler flow imaging and pulsed-wave Doppler (PW) examinations of the portal vein were performed in 282 subjects. The waveforms of the velocity tracings in the portal main trunk and its branches were determined to infer APF or CTS. Suspected cases of APFs or CTSs were always confirmed by echocardiography, contrast-enhanced ultrasound, computed tomography, or digital subtraction angiography findings. The portal maximum velocity (Vmax), minimum velocity(Vmin), Vmax/Vmin, arterial peak systolic velocity and resistance index, and venous reverse and forward velocities were used to estimate their haemodynamics.ResultsThe waveform of the velocity tracing for the draining portal vein of APF was typically arterial-like or diphase, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape. The flow in the affected portal vein was always hepatofugal in an intrahepatic patient, whereas a hepatopetal flow was observed in an extrahepatic APF patient. The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing. The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.ConclusionsPortal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

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Transhepatic ultrasound guided embolization as a successful novel technique in treatment of pediatric complex intrahepatic arterioportal fistula: a case report and review of the literature

Taher,

Kidr,

Kamal

et al. 2023

J Med Case Reports

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Introduction Intrahepatic vascular shunts “IHVS” are abnormal communications between intra-hepatic vasculature involving the arterial, portal, or hepatic venous system. Arterio-portal fistula “APF” is an intrahepatic communication between the hepatic arterial system and the portal venous system without any communication with the systemic venous circulation. APF is considered a rare cause of portal hypertension and gastrointestinal bleeding in infancy. Case presentation A 3-month-old Mediterranean female with known cardiac congenital anomalies presented to us with abdominal distension and diarrhea. Ultrasonography revealed massive ascites and computerized tomography (CT) abdomen with intravenous (IV) contrast revealed a left hepatic lesion. On further evaluation, an intrahepatic arterio-portal vascular malformation was detected. Attempted trans arterial embolization failed and radiology team successfully carried out direct trans hepatic ultrasound guided coiling of the aneurysmal venous sac followed by successful resection of segment 4 of the liver with the vascular malformation avoiding life threatening intra operative bleeding. Conclusion Any child with recurrent gastrointestinal bleeding, failure to thrive, vomiting, diarrhea, steatorrhea, splenomegaly, or ascites should be investigated for intrahepatic arterio-portal fistula “IAPF”. Our novel technique of direct trans hepatic ultrasound guided coiling is an alternative method if trans arterial embolization “TAE” failed.

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Severe gastrointestinal tract bleeding in a two-month-old infant due to congenital intrahepatic arterioportal fistula

Cited by 4 publications

References 18 publications

Hepatoportal Fistula in an 83-Year-Old Male, Presenting With Hematemesis 52 Years After Blunt Trauma

Hepatoportal Fistula in an 83-Year-Old Male, Presenting With Hematemesis 52 Years After Blunt Trauma

Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance

Transhepatic ultrasound guided embolization as a successful novel technique in treatment of pediatric complex intrahepatic arterioportal fistula: a case report and review of the literature

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