Coil embolization of arterioportal fistula complicated by gastrointestinal bleeding after Caesarian section: A case report

doi:10.12998/wjcc.v9.i2.403

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Jan 16, 2021; 9(2): 403-409
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.403

Coil embolization of arterioportal fistula complicated by gastrointestinal bleeding after Caesarian section: A case report

Suren Agho Stepanyan, Tigran Poghosyan, Karen Manukyan, Gagik Hakobyan, Hayk Hovhannisyan, Hayk Safaryan, Elena Baghdasaryan, Manik Gemilyan

Suren Agho Stepanyan, Hayk Safaryan, Department of Surgery No. 1, Yerevan State Medical University, Yerevan 0025, Armenia

Tigran Poghosyan, Department of Vascular Surgery, National Center of Oncology, Yerevan 0052, Armenia

Karen Manukyan, Department of Endoscopy, Mikaelyan University Hospital, Yerevan 0052, Armenia

Gagik Hakobyan, Manik Gemilyan, Department of Gastroenterology and Hepatology, Yerevan State Medical University, Yerevan 0025, Armenia

Hayk Hovhannisyan, Department of Surgery, Masis Medical Center, Masis 0801, Armenia

Hayk Safaryan, Department of Surgery, Mikaelyan Institute of Surgery, Yerevan 0052, Armenia

Elena Baghdasaryan, Department of Radiology, Armenia Medical Center, Yerevan 0078, Armenia

Author contributions: Stepanyan SA supervised the surgical care of patient, designed and drafted manuscript, edited text and figures, and organized manuscript language proofreading; Poghosyan T performed coil embolization and wrote manuscript text; Manukyan K performed endoscopic variceal band ligation and wrote manuscript text; Hakobyan G performed Gastroenterology consultation and wrote manuscript text; Hovhannisyan H performed abdominal drainage and wrote manuscript text; Safaryan H was attending surgeon of the patient and wrote manuscript text; Baghdasaryan E performed and interpreted CT imaging and wrote manuscript text; Gemilyan M performed Gastroenterology consultation and follow-up, wrote and edited manuscript text, organized references, formatted manuscript according to journal standards, and submitted manuscript; all authors have reviewed and agreed on the final version of manuscript.

Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Conflict-of-interest statement: The authors have no conflict of interest to disclose.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Manik Gemilyan, MD, Assistant Professor, Department of Gastroenterology and Hepatology, Yerevan State Medical University, 2 Koryun st, Yerevan 0025, Armenia. mgemilyan@yahoo.co.uk

Received: July 9, 2020
Peer-review started: July 9, 2020
First decision: October 27, 2020
Revised: November 26, 2020
Accepted: December 10, 2020
Article in press: December 10, 2020
Published online: January 16, 2021
Processing time: 183 Days and 1.2 Hours

Abstract

BACKGROUND

Most intrahepatic arterioportal fistulae (IAPF) are acquired. The few cases of congenital fistulae are diagnosed in infants and children.

CASE SUMMARY

We report a 31-year-old female patient presenting with haematemesis and melena three weeks after delivering her second child. The patient had a 20-year history of abdominal distention and nausea. IAPF, along with splenomegaly and ascites, was found by Doppler sonography and confirmed by computed tomography angiography. The patient was treated with endovascular coil embolization, resulting in occlusion of the fistula.

CONCLUSION

This was an unusual case of possible congenital IAPF that manifested during a second pregnancy and was complicated by portal hypertension.

Keywords: Intrahepatic fistula; Coil embolization; Portal hypertension; Case report; Occlusion; Arterioportal fistula

Core Tip: Our study describes an unusual case of possible congenital intrahepatic arterioportal fistula that manifested during a second pregnancy and was complicated by portal hypertension. Coil embolization of the fistula provides a less invasive and effective therapeutic option in this case. Only 35 cases of congenital intrahepatic arterioportal fistula were reported until 2015, and no case in the peripartum setting was described.