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- W1563379077 abstract "An anastomosis between the hepatic artery and the portal vein is called an arterioportal fistula. The majority of these fistulae (75%) are located within the liver. Several causes have been described including blunt or penetrating trauma, iatrogenic procedures, congenital vascular malformations, tumors, aneurysms, liver disease (usually cirrhosis) and infections. While small fistulae can be asymptomatic, larger fistulae may present with portal hypertension or a mesenteric steal syndrome. Symptoms at presentation can include gastrointestinal bleeding, ascites, cardiac failure, abdominal pain and diarrhea. Physical examination often reveals signs of portal hypertension as well as a continuous murmur (bruit) over the liver. Liver function tests may be abnormal and the fistula can usually be demonstrated by ultrasonography with Doppler, computed tomography or magnetic resonance imaging. However, most patients proceed to angiography as the definitive diagnostic procedure. The patient illustrated below was a 55-year-old man who presented with abdominal pain after meals and persistent diarrhea. His symptoms began after a suicidal stab wound into the abdomen 8 months previously. Screening blood tests including liver function tests were within the reference range. However, abdominal ultrasonography with Doppler showed marked dilatation of the left portal vein with an arterial waveform in the lateral segment (Figure 1). An abdominal computed tomography scan showed engorgement of the right and left portal veins, a superior mesenteric vein of small caliber and edematous thickening of the entire colonic wall. A celiac angiogram detected an abnormal shunt in which the left hepatic artery drained into the portal vein (Figure 2). A superior mesenteric angiogram also showed flow into the left hepatic artery via duodenal collaterals. The initial treatment was an attempt to close the fistula using embolization of the left hepatic artery with N-butyl-cyanoacrylate and microcoils. However, this was unsuccessful and was followed by surgical ligation of the left hepatic artery. Surgery was followed by a rapid reduction in abdominal pain and with resolution of diarrhea. In the above case, we attribute abdominal pain and diarrhea to a decrease in blood flow in mesenteric arteries causing intestinal ischemia. The majority of patients with intrahepatic arterioportal fistulae can be treated by embolization of the hepatic artery but, in a minority, this may fail because of large fistulae with rapid flow rates. Extrahepatic arterioportal fistulae are usually treated by surgery. Contributed by" @default.
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- W1563379077 date "2011-09-22" @default.
- W1563379077 modified "2023-09-23" @default.
- W1563379077 title "Hepatobiliary and Pancreatic: Traumatic hepatic arterioportal fistula" @default.
- W1563379077 doi "https://doi.org/10.1111/j.1440-1746.2011.06858.x" @default.
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