Traumatic Arterio-Portal Fistula: A Case Report

創傷引起之動脈門靜脈瘻管：病例報告

陳智良(Chih-Liang Chen) ； 許競文(Jing- Wen Sheu) ； 張宗泓(Tsung-Hung Chang)

《中華民國急救加護醫學會雜誌》 13卷3期 (2002/09) Pp. 103-108

https://doi.org/10.30018/JECCM.200209.0002

摘要

動脈門靜脈瘻管是一種少見的疾病。一位三十三歲女性因為吐血及黑便而住院，病患曾因腹部穿刺傷在他院接受剖腹探查術。病患於急診時上腹部可聽見嘈音，胃鏡顯示有出血之食道靜脈瘤及胃靜脈瘤，臨床上呈現門靜脈高壓及相關併發症，然檢查結果卻顯示不像是因肝硬化導致的。因上腹部可聽見嘈音而安排腹腔動脈血管攝影，結果呈現固有肝動脈及門靜脈間之瘻管，但血管攝影術中嘗試將瘻管栓塞失敗，因此改為剖腹探查術，我們嘗試將瘻管分開但相當困難，因此將連接至門靜脈之所有動脈結紮。病人術後順利，十天後出院，四個月後另一次的血管攝影顯示並無瘻管，病人一年後門診追蹤良好。

關鍵字

動脈門靜脈瘻管 ； 門脈高壓 ； 固有肝動脈 ； 門靜脈

並列摘要

Arterioportal fistulas (APFs) are rare vascular disorders of the mesenteric circulation. A 33-year-old woman was admitted due to hematemesis and passage of tarry stool. Her medical history was significant for a stab injury over epigastrium five years previously. At that time , a laparotomy was performed at another hospital.
A bruit was heard over upper abdomen in the emergent room. Panendoscopy revealed bleeding esoph-ageal varices and gastric varices. The cilincal presentation suggested portal hypertension and its relative complication. However, cirrhosis of the liver seemed less likely after a series of studies. Celiac angiogra-phy showed an A-V fistula between the proper hepatic artery and main portal vein. Angiographic embo-lization failed. So, we dissected and ligated the feeding arteries. The postoperative course was smooth, and the patient was discharged tem days later. Four months later, repeated angiography showed no fistula.
The patient was well one year later.

並列關鍵字

Arterioportal fistula (APF) ； portal hypertension ； proper hepatic artery ； portal vein