Spontaneous liver bleeding in a patient with congenital arterioportal fistulisation Presentation of a casus princeps and review of the literature

We present the first case reported in the literature describing spontaneous liver haemorrhage due to diffuse arterioportal fistu- lae. A 48-year old Caucasian woman was admitted to the hospital complaining of acute epigastric pain eradiating to the right shoul- der. Patient never had any penetrating or blunt abdominal trauma in the past nor any intervention on the liver. CT scan of the abdo- men revealed a subcapsular haematoma originating from two bleeding sites in the right liver lobe. Arteriography of the common hepatic artery showed opacification of the portal branches, indica- tive of an arterioportal fistula. A hypertrophic feeding branch of the right hepatic artery was then embolized, resulting in disappear- ance of the fistula. After complete resolution of the haematoma, investigations to detect underlying liver lesions were repeatedly negative. Therefore we conclude that a diffuse congenital arterio- portal fistula was the cause of spontaneous bleeding. This is to our knowledge the first case in whom a spontaneous liver bleeding secondary to diffuse arterioportal fistulisation is reported. A review of the literature regarding arterioportal fistulas and regarding the possible aetiology of spontaneous liver haematomas is provided. (Acta gastroenterol. belg., 2013, 76, 62-65).