title: Idiopathic intrahepatic arterioportal fistula treated by hepatectomy assisted by balloon-occluded retrograde transvenous obliteration: Report of an elderly case.
abstract: An 80-year-old woman with hepatic encephalopathy and esophagogastric varices was admitted. Doppler sonography and arteriography demonstrated an arterioportal fistula in the right anterior superior segment of the liver. Two attempts at transcatheter arterial embolization failed to manage the fistula and portacaval collaterals. We carried out hepatectomy and balloon-occluded retrograde transvenous obliteration, by which the portal flow changed from hepatofugal to hepatopetal. The resected specimen demonstrated multiple small holes in the right portal vein, which are arterioportal fistula. The underlying liver was normal. After treatment, esophagogastric varices and hepatic encephalopathy were markedly improved. Hepatectomy is useful as a reliable therapy for arterioportal fistula in case of failure of transarterial embolization.
authors.affiliation: Department of Surgery, Tottori University, Yonago, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Kuroda
authors.forename: Keiko
authors.initials: K
authors.lastname: Hosho
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koda
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Murawaki
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Ouchi
authors.forename: Toshio
authors.initials: T
authors.lastname: Kaminou
authors.forename: Akemi
authors.initials: A
authors.lastname: Iwamoto
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Hirooka