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Zentralbl Chir 2000; 125(Heft 12): 983-986
DOI: 10.1055/s-2000-10074
Der interessante Fall

J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG

Die posttraumatische intrahepatische arterioportale Fistel

U. Eickhoff1 , M. Kemen1 , E. Kollig3 , V. Zumtobel2 , M. Senkal
  • 1Chirurgische Abteilung (Chefärzte: Prof. Dr. M. Kemen, Priv.-Doz Dr .U. Eickhoff) des Evangelischen Krankenhauses Herne
  • 2Chirurgische Klinik (Direktor: Prof. Dr. V. Zumtobel) der Ruhr-Universität Bochum, St. Josef-Hospital Bochum
  • 3Klinik für Unfall- und Wiederherstellungs-Chirurgie (Direktor: Prof. Dr. G. Muhr) der Ruhr-Universität Bochum, Bergmannsheil Bochum
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Publication History

Publication Date:
31 December 2000 (online)

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The posttraumatic arterioportal intrahepatic fistula

Summary

Traumatic arterioportal fistulas (APF) are very rare. The most common reasons are liver biopsy and liver injuries. They are also caused by liver tumours and vessel anomalies. This is a case-report of a patient who developed an APF after blunt abdominal trauma. The fistula bearing part of the liver was resected in two sessions. In cases of large APFs with a flow from multiple collaterals the therapy of choice is the embolization. If not possible a selective excision of the fistulous sac or the resection of the fistula containing liver segment are recommended.

Zusammenfassung

Traumatisch bedingte arterioportale Fisteln (APF) sind sehr selten. Ursachen sind überwiegend Feinnadelbiopsien oder Zustände nach Leberrupturen. Auch im Zusammenhang mit Lebertumoren oder Gefäßanomalien werden APF diagnostiziert. Es wird über einen Patienten berichtet, der nach einem stumpfen Bauchtrauma eine APF entwickelt hat und bei dem in zwei operativen Sitzungen der fisteltragende Leberabschnitt erfolgreich saniert wurde. Bei großen APF mit multiplen Zuflüssen ist die Embolisation die primäre Therapie. Falls diese nicht gelingt und es von der Lokalisation möglich ist, sollte als nächstes Verfahren die selektive chirurgische Exstirpation des Fistelsacks oder die Resektion des fisteltragenden Leberabschnitts angestrebt werden.

Key words

Arterioportal fistula - liver injury - excision of ¿fistula - embolization

Schlüsselwörter

Arterioportale Fistel - Leberruptur - Fistelexstirpation - Embolisation

Literatur

  • 1 Aithal G P, Alabdi B J, Rose J D, James O F, Hudson M. Portal hypertension secondary to arterio-portal fistulae: two unusual cases.  Liver. 1999;  19 343-347
    PubMedGoogle Scholar
  • 2 Balci N C, Semelka R C, Sandhu J S. Intrahepatic arterioportal fistula: gadolinuim-enhanced 3D magnetic resonance angiography findings and angiographic embolization with steel coils.  Magn Reson Imaging. 1999;  17 475-478
    PubMedGoogle Scholar
  • 3 Benner G F, Cox E F, Baxton R W. Unusual arteriovenous fistula involving hepatic artery, portal vein and internal iliac venels. Care reports and a review of the literature.  Ann Surg. 1967;  33 276-288
    PubMedGoogle Scholar
  • 4 Creeck O, Gantt J, Ursen H. Traumatic arteriovenous fistulae at unusual sites.  Ann Surg. 1965;  161 908-920
    PubMedGoogle Scholar
  • 5 Down N K, Makowka L, Langer B, Colapinto R, Wense R H. Successful treatment of atraumatic hepatic artery-portal arteriovenous fistula by interpositional mesocaval shunting.  Canad J Surg. 1987;  2 117-119
    PubMedGoogle Scholar
  • 6 Farrel R, Steinmann A, Green W H. Arterio-venous shunting in regenerating liver simulating hepatoma.  Radiology. 1972;  102 279-280
    PubMedGoogle Scholar
  • 7 Foley W J, Tuncotte J G, Hoshins P A. Intrahepatic arteriovenous fistulas between the hepatic artery and the portal vein.  Ann Surg. 1971;  174 849-855
    PubMedGoogle Scholar
  • 8 Grabbe E, Jend H H. Arteriovenöse Fisteln in der Leber.  Fortschr Röntgenstr. 1982;  136 386-390
    PubMedGoogle Scholar
  • 9 Häring R. Interdisciplinary management of portal hypertension: status of portosystemic shunt operations.  Zentralbl Chir. 1995;  120 95-102
    PubMedGoogle Scholar
  • 10 Ishigami K, Yoshimutsi K, Honda H, Kuroiwa T, Irie H, Aibe H, Tajima T, Hashizume M, Masuda K. Coil embolization of arterioportal fistula that developed after partial gastrectomy.  Cardiovasc Intervent Radiol. 1999;  22 328-330
    PubMedGoogle Scholar
  • 11 Jenkins R L, Gealy R, Pomposelli J J, Pomfret E A, Gordon F, Lewis W D. Distal splenorenal shunt: role, indications, and utility in the era of liver transplantation.  Arch Surg. 1999;  134 416-420
    CrossrefPubMedGoogle Scholar
  • 12 Kirchgatterer A, Baldinger C, Lenglinger F, Frohler W, Meindl S, Zisch R, Kramar R. Portal hypertension due to traumatic hepatic arterioportal fistula: report of successful embolization.  Eur J Gas-troenterol Hepatol. 1998;  10 1057-1059
    PubMedGoogle Scholar
  • 13 La Berge J M, Ring E J, Lake J R. Transjugular intrahepatic portosystemic shunts (TIPS): preliminary results in 25 patients.  J Vasc Surg. 1992;  16 258-260
    PubMedGoogle Scholar
  • 14 Lee S J, Lim J H, Lee W J, Lim H K, Choo S W, Choo I W. Transient subsegmental hepatic parenchymal enhancement on dynamic CT: a sign of postbiopsy arterioportal shunt.  J Comput Assist Tomogr. 1997;  21 355-360
    CrossrefPubMedGoogle Scholar
  • 15 Lewis R, Roberts M D, Patrick S, Kenneth M D. Pathophysiologic and treatment of visceral hemorhage.  Mayo Clin Proc. 1996;  71 973-983
    CrossrefPubMedGoogle Scholar
  • 16 Lin S L, Lee C M, Kong M S, Lu C S, You C M. Congenital hepatic arterioportal fistula complicated with gastrointestinal bleeding treated with transcatheter embolization: case report.  Chang Keng I Hsueh Tsa Chir. 1999;  22 106-110
    PubMedGoogle Scholar
  • 17 Lumsden A B, Allen R C, Sreeram S, Atta H, Salam A. Hepatic arterioportal fistula.  Am Surg. 1993;  59 722-726
    PubMedGoogle Scholar
  • 18 Mooney C S, Honacker A D, Griffin W O. Influence of the liver on arteriovenous fistulas.  Arch Surg. 1970;  100 154-162
    PubMedGoogle Scholar
  • 19 Nakayama T, Hiyama Y, Ohnisi K, Tsuchiaya S, Khono K, Okuda K. Arterioportal shunts on dynamic computed tomography.  Ann J Radiology. 1983;  140 953-957
    PubMedGoogle Scholar
  • 20 Nolte W, Wiltfang J, Schindler C, Munke H, Unterberg K, Zumhasch U, Figulla H R, Werner G, Hartmann H, Ramadori G. Portosystemic encephalopathy after transjugular portosystemic shunt in patients with cirrhosis: clinical, laboratory, psychometric, and ectroencephalographic investigations.  Hepatology. 1998;  28 1215-1225
    CrossrefPubMedGoogle Scholar
  • 21 Okuda K, Musha H, Yamasaki T. Angiographic demonstration of intrahepatic arterioportal anastomoses in hepatocellular carcinoma.  Radiology. 1977;  122 53-58
    PubMedGoogle Scholar
  • 22 Okuda K, Musha H, Nakajima Y, Takayasu K, Suzuki S, Masahiko M, Yamasaki T. Frequency of intrahepatic arteriovenous fistula as a sequela to percutaneous needle puncture of the liver.  Gastroenterology. 1978;  74 1204-1207
    PubMedGoogle Scholar
  • 23 Ramchanadi P, Goldenberg N J, Soulen R L, White R I. Isobutyl 2-cyanoacrylate embolization of a hepatoportal fistula.  Ann J Radiology. 1983;  140 137-140
    PubMedGoogle Scholar
  • 24 Ryon K G, Lober S H. Traumatic fistula between hepatic artery and portal vein. Report of case.  N Engl J Med. 1968;  279 1215-1216
    PubMedGoogle Scholar
  • 25 Sachs R. Zur Kasuistik der Gefäßerkrankungen.  Dtsch Med Wochenschr. 1992;  18 443-447
    PubMedGoogle Scholar
  • 26 Scalfani S J A, Narayanaswamy T, Michel W C. Radiologic management of traumatic hepatic arterioportal arteriovenous fistulas.  J Trauma. 1981;  21 576-581
    PubMedGoogle Scholar
  • 27 Schilling J A, McKee F W. Late follow-up on experimental hepatic-portal arteriovenous anastomosis.  Surg Gynecol Obstet. 1950;  90 473-480
    PubMedGoogle Scholar
  • 28 Schmidt B, Bhatt G M, Abo M N. Management of posttraumatic vascular malformations of the liver by catheter embolization.  Am J Surg. 1980;  140 332-335
    CrossrefPubMedGoogle Scholar
  • 29 Takayusa K, Moriyama N, Ishkawa T, Shima Y, Goto H, Muramatsu Y, Yamada T. Large spontaneous intrahepatic arteriportal fistula demonstrated by rapid sequential computed tomography scan.  Gastroenterology. 1985;  88 564-570
    PubMedGoogle Scholar
  • 30 Van Haeften F F, Bröker F H L. Posttraumatic intrahepatic arteriovenous fistula.  Injury. 1984;  15 311-315
    CrossrefPubMedGoogle Scholar
  • 31 Van Way C W, Crane J M, Riddell D H, Forster J H. Arteriovenous fistula in the portal circulation.  Surgery. 1971;  70 876-890
    PubMedGoogle Scholar
  • 32 Vollmer J. Traumatische arteriovenöse Fistel.  Zentralbl Chir. 1964;  50 1930-1939
    PubMedGoogle Scholar
  • 33 Weigert C. In die Milzvene geborstenes Aneurysma einer Milzarterie.  Arch Path Anat (Virchow). 1886;  104 26-29
    PubMedGoogle Scholar
  • 34 Williams D B, Payne W S, Foulk W J. Splenic-arteriovenous fistula.  Mayo Clin Proc. 1980;  55 383-386
    PubMedGoogle Scholar
  • 35 Winograd J, Palubinskas A J. Arterioportal venous shunting in cavernous hemangioma of the liver.  Radiology. 1977;  122 331-332
    PubMedGoogle Scholar
  • 36 Zacks S I, Sandler R S, Biddle A K, Mauro M A, Brown R S. Decision-analysis of transjugular intrahepatic portosystemic shunt versus distal splenorenal shunt for portal hypertension.  Hepatology. 1999;  29 1399-1405
    CrossrefPubMedGoogle Scholar
  • 37 Zemel G, Katzen B T, Becker G J, Benenati J F, Sallee D J. Percutaneous transjugular porto-systemic shunt.  JAMA. 1991;  266 390-393
    CrossrefPubMedGoogle Scholar

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