A case of diffuse hepatic arteriovenous fistulae with hepatic encephalopathy, postprandial abdominal pain and biliary injury

Akira Kawano, Hirohisa Shigematsu, Toshihiro Maruyama, Hideyuki Nomura, Shinji Shimoda

Research output: Contribution to journalArticle

Abstract

A 60-year-old woman with hepatic encephalopathy was admitted to our hospital Ultrasonography, computed tomography and hepatic arteriography revealed diffuse hepatic arteriovenous fistulae (HAVF). Overt portosystemic shunt could not be identified. Right heart catheterization showed increased cardiac output. However the patient had never shown any signs of heart failure. Other than that, marked hepatopetal arterial flow from some branches of the superior mesenteric artery was detected and mesenteric arterial flow remarkably decreased. Extensive HAVF can lead to significant complications, including high output heart failure, pulmonary hypertension, portal hypertension, hepatic encephalopathy, biliary ischemia, cirrhosis, postprandial abdominal pain, and reduced liver function. Embolization or ligation of the hepatic artery provides temporal improvement of clinical symptoms, but long-term results are unsatisfactory because of the development of collateral circulation and the risk of refractory intrahepatic cholangitis, subsequently leading to liver failure. Liver transplantation offers another therapeutic option and can be a successful curative treatment.

Original languageEnglish
Pages (from-to)1039-1048
Number of pages10
JournalJournal of Japanese Society of Gastroenterology
Volume106
Issue number7
Publication statusPublished - Dec 18 2009

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Hepatic Encephalopathy
Arteriovenous Fistula
Abdominal Pain
Liver
Wounds and Injuries
Heart Failure
Surgical Portasystemic Shunt
Collateral Circulation
Cholangitis
Superior Mesenteric Artery
Biliary Liver Cirrhosis
Hepatic Artery
Liver Failure
Portal Hypertension
Cardiac Catheterization
Pulmonary Hypertension
Cardiac Output
Liver Transplantation
Ligation
Ultrasonography

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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A case of diffuse hepatic arteriovenous fistulae with hepatic encephalopathy, postprandial abdominal pain and biliary injury. / Kawano, Akira; Shigematsu, Hirohisa; Maruyama, Toshihiro; Nomura, Hideyuki; Shimoda, Shinji.

In: Journal of Japanese Society of Gastroenterology, Vol. 106, No. 7, 18.12.2009, p. 1039-1048.

Research output: Contribution to journalArticle

Kawano, Akira ; Shigematsu, Hirohisa ; Maruyama, Toshihiro ; Nomura, Hideyuki ; Shimoda, Shinji. / A case of diffuse hepatic arteriovenous fistulae with hepatic encephalopathy, postprandial abdominal pain and biliary injury. In: Journal of Japanese Society of Gastroenterology. 2009 ; Vol. 106, No. 7. pp. 1039-1048.
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