Post-traumatic intrahepatic arteriovenous fistula

A case is reported where, after multiple stab-wounds in the liver, a large intrahepatic arteriovenous fistula producing portal hypertension, a non-obstructive portal thrombus and chronic cholecystitis have developed. The fistula was closed by catheter embolization with surgical access to the left hepatic artery. Occlusion of the arterial flow at some distance from the fistula was rendered ineffectual by the collateral circulation. Deposition of a tufted steel coil exactly on the site of the fistula resulted in obliteration. The portal thrombus, supposedly developed from haemodynamic alterations, appeared to be resolved in a postoperative angiogram. Angiography and, to some degree, ultrasound B-scanning are indispensable for a timely detection of post-traumatic vascular malformations of the liver.