title: Spontaneous liver bleeding in a patient with congenital arterioportal fistulisation. Presentation of a casus princeps and review of the literature.
abstract: We present the first case reported in the literature describing spontaneous liver haemorrhage due to diffuse arterioportal fistulae. A 48-year old Caucasian woman was admitted to the hospital complaining of acute epigastric pain eradiating to the right shoulder. Patient never had any penetrating or blunt abdominal trauma in the past nor any intervention on the liver. CT scan of the abdomen 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, indicative of an arterioportal fistula. A hypertrophic feeding branch of the right hepatic artery was then embolized, resulting in disappearance 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 arterioportal 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.
authors: Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
authors: Toon
authors: T
authors: Steinhauser
authors: Sven
authors: S
authors: Francque
authors: Jan
authors: J
authors: Kunnen
authors: Jan
authors: J
authors: Holvoet
mesh_terms: D001164:Arteriovenous Fistula / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D011168:Portal System / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography