Transhepatic ultrasound guided embolization as a successful novel technique in treatment of pediatric complex intrahepatic arterioportal fistula: a case report and review of the literature

Transhepatic ultrasound guided embolization as a successful novel technique in treatment of pediatric complex intrahepatic arterioportal fistula: a case report and review of the literature

Introduction Intrahepatic vascular shunts "IHVS" are abnormal communications between intra-hepatic vasculature involving the arterial, portal, or hepatic venous system. Arterio-portal fistula "APF" is an intrahepatic communication between the hepatic arterial system and the porta...

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Bibliographic Details
Published in:Journal of medical case reports Vol. 17; no. 1; pp. 1 - 8
Main Authors: Taher, Heba, Kidr, ElSayed, Kamal, Ahmed, ElGobashy, Mohamed, Mashhour, Shady, Nassef, Amr, Tawfik, Sherifa, El Tagy, Gamal, Shaban, Muayad, Eltantawi, Haytham, Abdullateef, Khaled S
Format: Journal Article
Language:English
Published: London BioMed Central Ltd 15-09-2023
BioMed Central
BMC
Subjects:
Abdomen
Ascites
Blood
Care and treatment
Case Report
Case reports
Communication
Congenital arterioportal fistula
CT imaging
Diarrhea
Embolization
Failure to thrive
Fistula
Genetic disorders
Hypertension
Intrahepatic vascular shunts
Liver
Medical imaging
Portal hypertension
Thrombosis
Tomography
Trans hepatic embolization
Transarterial embolization
Ultrasonic imaging
Ultrasound imaging
Veins & arteries
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Summary:Introduction Intrahepatic vascular shunts "IHVS" are abnormal communications between intra-hepatic vasculature involving the arterial, portal, or hepatic venous system. Arterio-portal fistula "APF" is an intrahepatic communication between the hepatic arterial system and the portal venous system without any communication with the systemic venous circulation. APF is considered a rare cause of portal hypertension and gastrointestinal bleeding in infancy. Case presentation A 3-month-old Mediterranean female with known cardiac congenital anomalies presented to us with abdominal distension and diarrhea. Ultrasonography revealed massive ascites and computerized tomography (CT) abdomen with intravenous (IV) contrast revealed a left hepatic lesion. On further evaluation, an intrahepatic arterio-portal vascular malformation was detected. Attempted trans arterial embolization failed and radiology team successfully carried out direct trans hepatic ultrasound guided coiling of the aneurysmal venous sac followed by successful resection of segment 4 of the liver with the vascular malformation avoiding life threatening intra operative bleeding. Conclusion Any child with recurrent gastrointestinal bleeding, failure to thrive, vomiting, diarrhea, steatorrhea, splenomegaly, or ascites should be investigated for intrahepatic arterio-portal fistula "IAPF". Our novel technique of direct trans hepatic ultrasound guided coiling is an alternative method if trans arterial embolization "TAE" failed. Keywords: Intrahepatic vascular shunts, Portal hypertension, Congenital arterioportal fistula, Trans hepatic embolization, Transarterial embolization
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ISSN:1752-1947
1752-1947
DOI:10.1186/s13256-023-04047-0