Congenital hepatoportal arteriovenous fistula.
BACKGROUND
Two children with congenital hepatoportal arteriovenous fistulas have been investigated and treated surgically. These cases have been reviewed with five cases previously reported.


METHODS
Two children, 5 months and 14 months of age, presenting with failure to thrive, hepatosplenomegaly, ascites, and recurrent gastrointestinal bleeding with evidence of portal hypertension, were found to have congenital hepatoportal arteriovenous fistulas.


RESULTS
Doppler ultrasonographic examination was important in identifying abnormal portal venous flow. Angiogram identified the fistulas, confirming the diagnosis. Both patients had significant portal hypertension (pressure more than 30 mm Hg). Surgical resection in one child was unsuccessful, but surgical ligation of the hepatic artery controlled the symptoms in both patients.


CONCLUSIONS
Rapid collateralization of the hepatic arterial blood supply made embolization a short-term therapeutic measure, and surgical ligation of the hepatic artery is the treatment of choice for congenital hepatoportal arteriovenous fistulas.
Department of Surgery, King's College Hospital, London, U.K.
N D
ND
Heaton
M
M
Davenport
J
J
Karani
A P
AP
Mowat
E R
ER
Howard
D001164:Arteriovenous Fistula / Q000151:congenital* / Q000601:surgery; D004621:Embolization, Therapeutic; D005183:Failure to Thrive / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006499:Hepatic Artery / Q000002:abnormalities*; D006529:Hepatomegaly / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D007223:Infant; D008026:Ligation; D008297:Male; D011169:Portal Vein / Q000002:abnormalities*; D013163:Splenomegaly / Q000209:etiology