Intrahepatic Arteriovenous Fistula Secondary to Penetrating Trauma: Report of Case and Selected Review of the Literature

Abstract

A traumatic arteriovenous fistula developed following penetrating liver trauma due to a gunshot wound. The initial liver injury was managed by over sewing the hepatic laceration and draining the area of injury. Post-operatively the patient developed the clinical triad of jaundice, gastrointestinal bleeding and abdominal pain consistent with hemobilia. Selective hepatic arteriography was utilized to confirm the diagnosis and to demonstrate an hepatic artery to portal vein fistula. The fistula was successfully occluded by transcatheter embo lization of the right hepatic artery. This case and a review of the literature illustrates two points. First, although traumatic hemobilia is relatively uncommon, and traumatic intrahepatic arteri ovenous fistulae are rare sequelae of trauma, the diagnosis should be considered when the triad of pain, jaundice and gastronintestinal bleeding occur following hepatic injury. Second, transcatheter embolization may be a useful alternative to operative intervention in management of the intrahepatic source of bleeding.