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Intrahepatic Arterioportal Fistula: A Rare Cause of Portal Hypertension After Deceased Donor Liver Transplant
- Source :
- Experimental and Clinical Transplantation. 18:645-648
- Publication Year :
- 2020
- Publisher :
- Baskent University, 2020.
-
Abstract
- A 43-year-old male patient, who received a deceased donor liver transplant for background ethanol-related decompensated cirrhosis, presented 7 months after transplant with mild abdominal distension and pain. On evaluation, the patient had thrombocytopenia, high serum-ascites albumin gradient ascites, and deranged liver functions. The Doppler study of the splenoportal axis showed hepatofugal flow in the recipient's portal vein, normal hepatic veins, a normal liver, splenomegaly, mild ascites, and multiple periportal collaterals. A transjugular liver biopsy and a hepatic venous pressure gradient measurement were done, which suggested mild portal tract inflammation with portal tract fibrosis with prominent portal venous thickening and normal hepatic venous pressure gradient (4 mm). However, the patient had a progressive increase in ascites and a dramatic increase in serum bilirubin level. A triple-phase computed tomography was done that showed rapid contrast flow in both the portal and hepatic arterial phase, suggesting arterialization of the portal flow with possible suspicion of a communicating arterioportal fistula. The patient underwent digital subtraction angiography, which was followed by an embolization of the arterioportal fistula. After embolization, serum bilirubin gradually decreased and ascites resolved. A repeat Doppler of the portal venous system showed established hepatopetal flow with progressively rising portal flow velocities.
- Subjects :
- Transplantation
medicine.medical_specialty
medicine.diagnostic_test
business.industry
medicine.medical_treatment
Portal venous pressure
Albumin
Portal venous system
Digital subtraction angiography
Abdominal distension
medicine.disease
Ascites
medicine
Portal hypertension
Radiology
Embolization
medicine.symptom
business
Subjects
Details
- ISSN :
- 21468427 and 13040855
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- Experimental and Clinical Transplantation
- Accession number :
- edsair.doi...........dd787df3afb93dc5388bd10732660029