Arteroportal fistula is a rare cause of prehepatic portal hypertension. A 44-year-old male with hepatitis virus C infection was admitted for acute variceal bleeding. Endoscopy showed the presence of large esophageal varices. The ultrasound revealed a mass near the head of pancreas, which was characterized at the color-Doppler by a turbulent flow, and arterialization of portal vein flow. CT scan of abdomen showed a large aneurysm of the gastroduodenal artery communicating into the superior mesenteric vein. The sinusoidal portal pressure measured as hepatic vein pressure gradient was normal, confirming the pre-hepatic origin of portal hypertension. The diagnosis of extrahepatic portal hypertension secondary to arteroportal fistula was established, and the percutaneous embolization was performed. Three months later, the endoscopy showed absence of esophageal varices and ascites. At the moment, the patient is in good clinical condition, without signs of portal hypertension.

译文

动脉门静脉瘘是肝前门静脉高压症的罕见原因。一名患有丙型肝炎病毒感染的44岁男性因急性静脉曲张出血而入院。内窥镜检查显示存在大的食管静脉曲张。超声显示胰头附近有肿块,在彩色多普勒处其特征是湍流和门静脉血流的动脉化。腹部ct扫描显示胃十二指肠动脉的大动脉瘤连通到肠系膜上静脉。以肝静脉压力梯度测量的正弦门静脉压力正常,证实了门静脉高压的肝前起源。建立了继发于动脉门静脉瘘的肝外门静脉高压症的诊断,并进行了经皮栓塞术。三个月后,内窥镜检查显示没有食管静脉曲张和腹水。目前,患者的临床状况良好,没有门静脉高压的迹象。

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