Case Report
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World J Gastroenterol. May 7, 2013; 19(17): 2714-2717
Published online May 7, 2013. doi: 10.3748/wjg.v19.i17.2714
Isolated arterioportal fistula presenting with variceal hemorrhage
Anupama Nookala, Behnam Saberi, Ramon Ter-Oganesyan, Gary Kanel, Phillip Duong, Takeshi Saito
Anupama Nookala, Behnam Saberi, Phillip Duong, Takeshi Saito, Division of Gastroenterology and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, CA 90033, United States
Ramon Ter-Oganesyan, Department of Radiology, University of Southern California, Los Angeles, CA 90033, United States
Gary Kanel, Department of Pathology, University of Southern California, Los Angeles, CA 90033, United States
Author contributions: Nookala A was the primary author in gathering information regarding the case, helped to coordinate the different authors in acquiring the information and figures, primary author in reviewing the literature and analyzing it as it pertained to the case and primary drafter of the manuscript; Saberi B assisted in critical revision of the manuscript for important intellectual content and review of the literature; Ter-Oganesyan R provided interventional radiological information on the case, Figure 1 images and legend, as well as assisting in critical review of the case; Kanel G provided pathological interpretation of liver biopsy, Figure 2 images and legend; Duong P assisted in gathering of information regarding the case and analyzing literature as it pertained to the case; Saito T assisted in the majority of critical revision of the manuscript for important intellectual content.
Correspondence to: Takeshi Saito, MD, PhD, Assistant Professor, Division of Gastroenterology and Liver Diseases, Department of Medicine, University of Southern California, 2011 Zonal Avenue, HMR 801A, Los Angeles, CA 90033, United States. saitotak@usc.edu
Telephone: +1-323-4422260 Fax: +1-323-4425425
Received: September 15, 2012
Revised: December 26, 2012
Accepted: January 11, 2013
Published online: May 7, 2013
Processing time: 233 Days and 11 Hours
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.

Keywords: Arterioportal fistula; Pre-sinusoidal portal hypertension; Hepatic vein pressure gradient; Hepatic artery embolization