A Case of Portal Hypertension Secondary to Intrahepatic Arterioportal Fistula

Kim, Woo Shik; Kim, Byung Ho; Park, Chul Young; Kim, Kyeong Jin; Oh, Joo Hyeong; Dong, Seok Ho; Chang, Young Woon; Lee, Jeoung Il; Chang, Rin

Abstract

Intrahepatic arterioportal fistulae are rare, but can induce serious complications such as portal hypertension. We present a patient who developed portal hypertension secondary to an intrahepatic arterioportal fistula which was successfully embolized with occlusive balloon and microcoils. A 47-year-old previously healthy male was admitted to our hospital following an episode of melena and abdominal distension. The noteworthy feature in his previous medical history was a hepatic injury caused by a traffic accident when he was aged 9. He didn't drink liquor at all. General appearance was pale and acutely ill. The abdomen was markedly distended and a very noisy bruit over the liver area was continously heard. Laboratory findings, including liver function tests were completely normal except for anemia (Hb 5.7g/dL) and hepatitis viral markers were all negative. Endoscopy demonstrated gastroesophageal varices as the source of bleeding which was treated with variceal ligation. Computed tomography showed a dilated vascular structure in the periphery of the liver at the arterial phase, which suggested a intrahepaic arterioportal fistula. The fistula was also subsequently identified with duplex ultrasound and angiography. Occlusion of the right hepatic artery was performed with occlusive balloon and microcoils. Ascites was rapidly corrected in accordance with a large amount of diuresis and gastroesophageal varices were also completely disappeared whithin a month. On follow-up examination 18 months after hepatic embolization, duplex ultrasound and selective angiography revealed a minute flow of blood through this fistula, but the patient remains well with no recurrence of signs of portal hypertension.