Successful treatment of a traumatic hepatic artery-portal vein arteriovenous fistula by interpositional mesocaval shunting.

Hepatic artery-portal vein fistula is an occasional sequel to invasive procedures on the liver, such as biopsy and transhepatic cholangiography. When the fistula is large it may result in portal hypertension, gastrointestinal bleeding and histologic and functional changes in the liver. Treatment is usually directed at the fistula, either embolizing, dividing or resecting it. Portal decompression has been discouraged in the past. The authors describe a case in which recurrent gastrointestinal bleeding, uncontrolled by attempts at embolization, was subsequently managed successfully by portosystemic shunting. They suggest that when the primary symptom related to the fistula is variceal bleeding, portal decompression is a reasonable therapeutic option.