54-year-old patient with depressive syndrome. She attended for attempted self-harm with penetrating stab wounds to the abdomen. At all times haemodynamically stable. Abdominal computed tomography (CT) showed pneumoperitoneum and free fluid. Urgent laparotomy was decided, with uncontrollable pulsatile bleeding from the left hepatic lobe. Packing was performed and the patient was transferred to a tertiary centre for arteriography. An angio-CT scan was requested, revealing a post-traumatic arteriovenous fistula and later arteriography, confirming a fistula of the left hepatic artery with suprahepatic and portal veins. The left hepatic artery was embolised with coils. It was reviewed 48 h later in the operating theatre and good hepatic perfusion was observed (Fig. 1). The CT scan shows the left hepatic artery (green arrow) which continues in the arterial phase with the left suprahepatic vein (blue star) and with the lateral branch of the left portal vein (orange circle). These findings suggest post-traumatic arteriovenous fistula-like vascular injury in the bed of the parenchymal lesions. Arteriography confirms the arteriovenous fistula (red circle) of the left hepatic artery (green arrow) with suprahepatic vein (blue star) and portal vein (orange circle).
Please cite this article as: Pérez Reyes M, Romacho López L, Neuhaus Nevado M, Priego-Puga Arjona T. Traumatismo hepático penetrante como causa de fístula arteriovenosa. Cir Esp. 2022;100:585.
