Therapeutic strategies for refractory variceal bleeding due to percutaneous liver biopsy: A case report
- Resource Type
- Authors
- Jose Ramos; John Cantrell; Chikwendu Ede
- Source
- International Journal of Surgery Case Reports
- Subject
- Varices
medicine.medical_specialty
medicine.medical_treatment
Fistula
CTHA, computed tomography hepatic arteriography
Case Report
03 medical and health sciences
0302 clinical medicine
Refractory
medicine
medicine.diagnostic_test
business.industry
Bleeding
food and beverages
Liver biopsy
medicine.disease
Surgery
medicine.anatomical_structure
Arterioportal fistula
030220 oncology & carcinogenesis
Portal hypertension
030211 gastroenterology & hepatology
IAPF, intrahepatic arterioportal fistula
business
Complication
Transjugular intrahepatic portosystemic shunt
Left lobe of liver
TIPS, Trans-jugular Intrahepatic Portosystemic Shunt
- Language
- ISSN
- 2210-2612
Highlights • Intrahepatic arterioportal fistula is an unusual complication of liver biopsy. • Intrahepatic arterioportal fistula can cause variceal bleeding. • Angioembolization is an effective treatment of variceal bleeding.
Introduction and importance Variceal bleeding due to intrahepatic arterioportal fistula is an unusual complication of percutaneous liver biopsy. As majority of variceal bleeding are cirrhotic in origin, the rare occurrence of an acquired intrahepatic arterioportal fistula presents a therapeutic dilemma. Case presentation We report the case of a 57-year-old female with refractory variceal bleeding that occurred six years after a percutaneous liver biopsy. As part of the workup for placement of Transjugular Intrahepatic Portosystemic Shunt, a computed tomography hepatic arteriography was performed. This revealed a large arterioportal fistula in left lobe of liver. Variceal bleeding was controlled following successful embolisation of the arterioportal fistula. Clinical discussion Persistent intrahepatic arterioportal fistula can result in portal hypertension and variceal bleeding. This is a rare complication of percutaneous liver biopsy that warrants consideration as an aetiology of portal hypertension with variceal bleeding. The therapeutic strategy for refractory bleeding due to intrahepatic arterioportal fistula is different from cirrhotic portal hypertension and requires trans-arterial embolisation of the fistula. Conclusion This case highlights the need to consider arterioportal fistula as an aetiology of portal hypertension as therapeutic strategy in refractory variceal bleeding is different from cirrhotic portal hypertension.