title: Extrahepatic portal obstruction without hepatopetal pathway associated with congenital arterioportal fistula: a case report.
abstract: Extrahepatic portal obstruction is one of the causes of portal hypertension, in which well-developed hepatopetal pathways are commonly recognized. Herein an extremely rare case of extrahepatic portal obstruction without hepatopetal pathway, probably caused by arterioportal fistula, is reported. The patient was a normally matured 16-year-old girl admitted for further evaluation of jaundice, presenting with the clinical manifestations of the portal hypertension associated with hypersplenism and portosystemic venous shunt. Celiac angiography clearly demonstrated an intrahepatic arterial aneurysm fed by the right hepatic artery shunting to the superior mesenteric vein, and portography disclosed complete obstruction of the portal trunk with conspicuous hepatofugal pathway but no hepatopetal collateral veins. The exact mechanism of this phenomenon is not known and whether the extrahepatic portal obstruction was primary or secondary is still obscure. However, this is the first case report in the world literature describing extrahepatic portal obstruction with absence of hepatopetal pathway.
authors.affiliation: Second Department of Internal Medicine, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Maeda
authors.forename: Y
authors.initials: Y
authors.lastname: Horie
authors.forename: M
authors.initials: M
authors.lastname: Koda
authors.forename: T
authors.initials: T
authors.lastname: Suou
authors.forename: H
authors.initials: H
authors.lastname: Andachi
authors.forename: K
authors.initials: K
authors.lastname: Nakamura
authors.forename: H
authors.initials: H
authors.lastname: Kawasaki
mesh_terms: D000293:Adolescent; D000783:Aneurysm / Q000151:congenital; D001164:Arteriovenous Fistula / Q000151:congenital*; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008642:Mesenteric Veins; D011168:Portal System / Q000002:abnormalities*; D011169:Portal Vein