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

被引:3
作者
Taher, Heba [1 ]
Kidr, Elsayed [1 ]
Kamal, Ahmed [1 ]
Elgobashy, Mohamed [2 ]
Mashhour, Shady [2 ]
Nassef, Amr [2 ]
Tawfik, Sherifa [3 ]
El Tagy, Gamal [2 ]
Shaban, Muayad [1 ]
Eltantawi, Haytham [1 ]
Abdullateef, Khaled S. [1 ]
机构
[1] Cairo Univ Kasr Al Einy, Specialized Pediat Hosp, Fac Med, Pediat Surg Dept, 1 Abou El Rish Sq, Cairo, Egypt
[2] Cairo Univ Kasr Al Einy, Fac Med, Dept Radiol, Cairo, Egypt
[3] Minist Hlth Cairo, Pathol Dept, Cairo, Egypt
关键词
Intrahepatic vascular shunts; Portal hypertension; Congenital arterioportal fistula; Trans hepatic embolization; Transarterial embolization; HEPATOPORTAL ARTERIOVENOUS-FISTULA; PORTAL-HYPERTENSION; HEPATIC-ARTERY; COIL EMBOLIZATION; LIVER; FLOW; SOLITARY;
D O I
10.1186/s13256-023-04047-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
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