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

Journal Volume 76 - 2013
Issue Fasc.1 - Case reports
Author(s) T. Steinhauser, Sven Francque, Jan Kunnen, Jan Holvoet
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(1) Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium ; (2) Department of Gastroenterology, (3) Department of Radiology, Ziekenhuis Netwerk Antwerpen, Campus Middelheim, Antwerp, Belgium.

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).

© Acta Gastro-Enterologica Belgica.
PMID 23650786