title: Isolated arterioportal fistula presenting with variceal hemorrhage.
abstract: We report a case of life-threatening hematemesis due to portal hypertension caused by an isolated arterioportal fistula (APF). Intrahepatic APFs are extremely rare and are a cause of presinusoidal portal hypertension. Etiologies for APFs are comprised of precipitating trauma, malignancy, and hereditary hemorrhagic telangiectasia, but these were not the case in our patient. Idiopathic APFs are usually due to congenital vascular abnormalities and thus usually present in the pediatric setting. This is one of the first cases of adult-onset isolated APF who presented with portal hypertension and was successfully managed through endoscopic hemostasis and subsequent interventional radiological embolization.
authors.affiliation: Division of Gastroenterology and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Anupama
authors.initials: A
authors.lastname: Nookala
authors.forename: Behnam
authors.initials: B
authors.lastname: Saberi
authors.forename: Ramon
authors.initials: R
authors.lastname: Ter-Oganesyan
authors.forename: Gary
authors.initials: G
authors.lastname: Kanel
authors.forename: Phillip
authors.initials: P
authors.lastname: Duong
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saito
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D001706:Biopsy; D004621:Embolization, Therapeutic; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006396:Hematemesis / Q000209:etiology; D016558:Hemostasis, Endoscopic; D006499:Hepatic Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D010690:Phlebography / Q000379:methods; D011169:Portal Vein / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Arterioportal fistula; Hepatic artery embolization; Hepatic vein pressure gradient; Pre-sinusoidal portal hypertension