[A case of diffuse hepatic arteriovenous fistulae with hepatic encephalopathy, postprandial abdominal pain and biliary injury].
A 60-year-old woman with hepatic encephalopathy was admitted to our hospital. Ultrasonography, computed tomography and hepatic arteriography revealed diffuse hepatic arteriovenous fistulae (HAVF). Overt portosystemic shunt could not be identified. Right heart catheterization showed increased cardiac output. However the patient had never shown any signs of heart failure. Other than that, marked hepatopetal arterial flow from some branches of the superior mesenteric artery was detected and mesenteric arterial flow remarkably decreased. Extensive HAVF can lead to significant complications, including high output heart failure, pulmonary hypertension, portal hypertension, hepatic encephalopathy, biliary ischemia, cirrhosis, postprandial abdominal pain, and reduced liver function. Embolization or ligation of the hepatic artery provides temporal improvement of clinical symptoms, but long-term results are unsatisfactory because of the development of collateral circulation and the risk of refractory intrahepatic cholangitis, subsequently leading to liver failure. Liver transplantation offers another therapeutic option and can be a successful curative treatment.
Kawano
Akira
A
Department of Internal Medicine, Kitakyushu Municipal Medical Center. kawanoa@intmed1.med.kyushu-u.ac.jp
Shigematsu
Hirohisa
H
Maruyama
Toshihiro
T
Nomura
Hideyuki
H
Shimoda
Shinji
S
D015746:Abdominal Pain / Q000209:etiology*; D001164:Arteriovenous Fistula / Q000150:complications*; D001649:Bile Duct Diseases / Q000209:etiology; D005260:Female; D006499:Hepatic Artery; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006503:Hepatic Veins; D006801:Humans; D008875:Middle Aged