Posttraumatic Intrapancreatic Aortosplenic Fistula Causing Portal Hypertension

Estrada, Óscar; Mestres, Carlos–A.; López-Boado, Miguel-A; Salmerón, Juan A; Visa, J; García-Valdecasas, J.C.

doi:10.1177/021849230301100322

Cited by 6 publications

(2 citation statements)

References 4 publications

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“…While the indications for NOM have expanded to include more severe hepatic injuries, a higher incidence of complications of NOM, such as bile leakage, bile peritonitis, missed injuries, hepatic abscesses, and delayed hemorrhage due to pseudoaneurysm formation, has been reported [3, 5, 6]. APF is a comparatively rare complication of liver injury; however, it can lead to portal hypertension, consequently resulting in gastrointestinal bleeding, mesenteric ischemia, and heart failure [7, 11]. The period between injury and the diagnosis of APF varies considerably, ranging from several days to more than 20 years [8, 12–14].…”

Section: Discussionmentioning

confidence: 99%

“…APF is rare; however, it is considered to be clinically dangerous due to the possibility of portal hypertension and ultimate rupture of esophageal varices. Therefore, transarterial embolization is usually performed in APF patients with clinical signs, such as splenomegaly or ascites, that are suggestive of portal hypertension [7–9]. On the other hand, no indications for treatment have been established in APF patients without symptoms, as the natural history of posttraumatic APF is not well understood.…”

Section: Introductionmentioning

confidence: 99%

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A Case Report of Spontaneous Closure of a Posttraumatic Arterioportal Fistula

Kittaka

Akimoto

Tashiro

2013

Case Reports in Emergency Medicine

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As the indications for the nonoperative management (NOM) of hepatic injury have expanded, the incidence of complications of NOM has increased. Among such complications, arterioportal fistula (APF) formation is rare, although dangerous, due to the potential for portal hypertension. Embolization is performed in APF patients with clinical signs suggestive of portal hypertension. Meanwhile, no indications for treatment have been established in APF patients without symptoms, as the natural history of posttraumatic APF is not well understood. We herein report the case of a 35-year-old female with severe hepatic injury (Grade IV on the Organ Injury Scale of the American Association for the Surgery of Trauma) due to a traffic accident. Her hemodynamic state remained stable, and an enhanced CT scan obtained on admission showed no extravasation of contrast medium, pseudoaneurysm formation, or APF; therefore, NOM was selected. Although the patient's physical condition was stable, an enhanced CT scan obtained 13 days after the injury showed APF in segment 8 of the liver. Although embolization was considered, the APF was not accompanied by portal dilatation suggestive of portal hypertension; hence, strict observation was selected. Consequently, follow-up CT performed on day 58 after the injury revealed spontaneous closure of the APF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Case Report of Spontaneous Closure of a Posttraumatic Arterioportal Fistula

Kittaka

Akimoto

Tashiro

2013

Case Reports in Emergency Medicine

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Medical and surgical management of portal hypertension in children

Superina

Alonso²

2006

Curr Treat Options Gastro

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The treatment of portal hypertension in children has undergone considerable evolution in the past decade. The treatment offered depends on the cause of the hypertension and the underlying health of the liver. The diagnosis of portal hypertension often can be made by the history and physical examination. Upper gastrointestinal bleeding in the presence of splenic enlargement is pathognomonic for portal hypertension. Bleeding and hypersplenism are the principal symptoms. Treatment of bleeding starts with confirming the diagnosis with esophageal and gastric endoscopy. The patient is admitted to an intensive care unit and started on intravenous octreotide. Banding or sclerosis of esophageal varices will result in cessation of the bleeding but not a permanent cure. A careful investigation for the cause of the portal hypertension should be done. This includes imaging studies of intra-abdominal arteries and veins, a liver biopsy, and liver function tests, including coagulation studies. For patients with extrahepatic portal vein thrombosis, early consideration should be given to surgical treatment with a meso-Rex bypass. Patients with liver disease should be treated for the underlying disorder and undergo regular endoscopic monitoring for recurrence of varices. Patients with well-compensated cirrhosis should be considered for selective surgical shunting, and those with advanced disease for liver transplantation. The benefit of long-term beta blockers in children has not been proven by clinical trials.

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