A case report of congenital umbilical arteriovenous malformation complicated with liver failure after surgical excision.
BACKGROUND
Few case reports of umbilical arteriovenous malformation (AVM) have been reported. Herein, we report a neonatal case of umbilical AVM who underwent liver failure after surgical excision.


METHODS
The patient was a girl delivered at a gestational age of 39+5 weeks showing cyanosis and heart murmur.


METHODS
Cardiac echography, abdominal ultrasonography (USG), and computed tomography revealed suspecting the umbilical AVM.


METHODS
On the eighth day after birth, because of the aggravation of heart failure, emergency surgery for excision of umbilical AVM was performed.


RESULTS
In postoperative state, worsened laboratory test of liver function and coagulopathy indicated the liver failure. Abdominal USG revealed that the portal vein (PV) flow primarily occurred from the left PV to the inferior vena cava via ductus venosus and coarse hepatic echogenicity. After conservative management, laboratory findings of liver function and the flow direction of the left PV were normal, as demonstrated by abdominal USG within 50th postoperative day.


CONCLUSIONS
Careful preoperative evaluation of an AVM of a large size with significant blood flow should be performed, and the possibility of liver failure after surgery should always be considered.
Department of Surgery, Seoul National University Children's Hospital, Seoul, Korea.
Ji-Won
JW
Han
Hyun-Young
HY
Kim
Sung-Eun
SE
Jung
D001165:Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017093:Liver Failure / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000002:abnormalities*; D014471:Umbilical Veins / Q000002:abnormalities*