1
|
Taher H, Kidr E, Kamal A, ElGobashy M, Mashhour S, Nassef A, Tawfik S, El Tagy G, Shaban M, Eltantawi H, Abdullateef KS. 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. J Med Case Rep 2023; 17:412. [PMID: 37710289 PMCID: PMC10503188 DOI: 10.1186/s13256-023-04047-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/19/2023] [Indexed: 09/16/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Heba Taher
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt.
| | - ElSayed Kidr
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Ahmed Kamal
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Mohamed ElGobashy
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | - Shady Mashhour
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | - Amr Nassef
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | | | - Gamal El Tagy
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | - Muayad Shaban
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Haytham Eltantawi
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Khaled S Abdullateef
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| |
Collapse
|
2
|
Xia J, Zhao J, Chang B. Case report: Congenital arterioportal fistula: An unusual cause of variceal bleeding in adults. Front Med (Lausanne) 2022; 9:970254. [PMID: 36160178 PMCID: PMC9489925 DOI: 10.3389/fmed.2022.970254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
The aberrant vascular connecting channel that forms between the portal vein and the hepatic artery is the essence of a hepatic arterioportal fistula. Congenital hepatic arterioportal fistula more frequently occurs in early childhood rather than in adults. We describe a rare instance of a large, isolated, congenital hepatic arterioportal fistula that was successfully treated following selective hepatic arteriography and transcatheter embolization. The patient presented with significant variceal bleeding when the fistula was discovered at the age of 73. The patient's condition improved during the brief postoperative follow-up period without a recurrence. Our research suggests that in older patients with portal hypertension and an unclear etiology, selective arteriography and embolization can provide a definitive diagnosis and successfully treat symptoms.
Collapse
Affiliation(s)
- Junlin Xia
- Department of Gastroenterology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jingwen Zhao
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bing Chang
- Department of Gastroenterology, The First Affiliated Hospital, China Medical University, Shenyang, China
- *Correspondence: Bing Chang
| |
Collapse
|
3
|
Yazici MU, Cil B, Bayrakci B, Sasmaz N, Baysoy G, Gurakan F. Transarterial and Transhepatic Endovascular Intervention to Alleviate Portal Hypertension Secondary to Arterioportal Fistula in a Trisomy 21 Infant. J Pediatr Intensive Care 2017; 7:54-58. [PMID: 31073469 DOI: 10.1055/s-0037-1603822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/10/2017] [Indexed: 12/15/2022] Open
Abstract
Individuals with trisomy 21 have an 80% risk reduction of vascular anomalies compared with general population. However, an association of trisomy 21 and portal vascular and arteriovenous anomalies has been defined in the literature. The primary hemodynamic abnormality in portal hypertension is increased resistance to portal blood flow. In various case reports in adults and pediatric age group patients, transarterial coil embolization of hepatoportal fistula was described. One of the authors of this article has previously reported successful treatment of congenital arterioportal fistula (APF) with percutaneous transhepatic liquid embolization in a patient who previously had transarterial coil embolization. To date, eight patients with trisomy 21 (Down syndrome) and congenital portosystemic shunts were reported of which four were treated with embolization. Here, we describe a 3-month-old infant with trisomy 21 and intrahepatic APF associated with extrahepatic portal hypertension and massive ascites. In the current report, a rare case of a patient with a diagnosis of trisomy 21 is discussed who was attempted to be treated with transarterial coil embolization and percutaneous transhepatic liquid embolization of the congenital APF in a single session.
Collapse
Affiliation(s)
- Mutlu Uysal Yazici
- Department of Pediatric Intensive Care, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Barbaros Cil
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatric Intensive Care, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Necati Sasmaz
- Department of Pediatric Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Gokhan Baysoy
- Department of Pediatric Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Figen Gurakan
- Department of Pediatric Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey
| |
Collapse
|
4
|
Portal vascular anomalies in Down syndrome: spectrum of clinical presentation and management approach. J Pediatr Surg 2010; 45:1676-81. [PMID: 20713219 DOI: 10.1016/j.jpedsurg.2010.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 03/09/2010] [Accepted: 03/10/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE The occurrence of portal vascular anomalies in Down syndrome has been sporadically reported in the literature. These rare disorders have a wide spectrum of anatomical and clinical presentations. The aim of this communication was to describe the clinical course, imaging features, and management approaches in patients with this association. METHODS We conducted a comprehensive search of the databases of the Vascular Anomalies Center and the Department of Radiology at Children's Hospital Boston for patients with Down syndrome and portal vascular anomalies. Medical records and imaging studies of varying modalities were reviewed. RESULTS Three children with Down syndrome and portal anomalies (portosystemic shunt, simple arterioportal shunt, complex arterioportal shunt) were managed at our institution. The portosystemic shunt was clinically insignificant and resolved without any intervention. The simple arterioportal shunt was successfully treated with embolization. The complex arterioportal shunt was associated with major congenital cardiac defects and the child ultimately expired despite a decrease in the arterioportal shunting after embolization. CONCLUSIONS Three is a wide spectrum of clinical and anatomical features of portal vascular shunts in Down syndrome. The management approach should be tailored based on the severity of symptoms. Percutaneous embolization can offer a safe, effective, and minimally invasive alternative to the surgical approach in selective cases.
Collapse
|
5
|
Norton SP, Jacobson K, Moroz SP, Culham G, Ng V, Turner J, John P. The congenital intrahepatic arterioportal fistula syndrome: elucidation and proposed classification. J Pediatr Gastroenterol Nutr 2006; 43:248-55. [PMID: 16877994 DOI: 10.1097/01.mpg.0000221890.13630.ad] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Congenital intrahepatic arterioportal fistula is a rare but treatable cause of portal hypertension for which early recognition may lead to successful radiological management. We report an infant presenting with severe failure to thrive, melena and splenomegaly due to a congenital intrahepatic arterioportal fistula, successfully ablated after multiple trials of superselective transarterial embolization. Comprehensive review of congenital cases provides an understanding of the key clinical features defining this syndrome. A classification system is proposed, upon which treatment decisions may be based.
Collapse
Affiliation(s)
- Seamus P Norton
- Department of Pediatrics, British Columbia's Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | | | | | | | | |
Collapse
|
6
|
Aarts R, Ijland MM, de Blaauw I, Hoogeveen Y, Boetes C, van Proosdij M. Severe gastrointestinal tract bleeding in a two-month-old infant due to congenital intrahepatic arterioportal fistula. Eur J Radiol 2006; 59:25-8. [PMID: 16704913 DOI: 10.1016/j.ejrad.2006.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 02/24/2006] [Accepted: 03/01/2006] [Indexed: 12/24/2022]
Abstract
A 2-month-old boy was referred for assessment of severe upper gastrointestinal tract bleeding and melena. On physical examination, a continuous murmur was heard over the right upper quadrant of the abdomen. A splenomegaly and dilated veins were also noted on the abdominal wall. Liver functions were normal. There was no history of trauma or jaundice. Doppler ultrasonography, magnetic resonance arteriography and angiography suggested the presence of an intrahepatic arteriovenous fistula between the phrenic artery and the portal vein. Management consisted of successful embolization by coiling of the phrenic artery. To our knowledge this is the first documented case report of a congenital fistula between the phrenic artery and the portal vein.
Collapse
Affiliation(s)
- R Aarts
- Department of Radiology, University Medical Center St. Radboud, 6500 HB Nijmegen, The Netherlands
| | | | | | | | | | | |
Collapse
|