Mesenteric ischemia: An unusual presentation of traumatic intrahepatic arterioportal fistula

Traumatic hepatic arterioportal fistulae (APF) are described infrequently a s sequelae of hepatic trauma. These anomalies are usually associated with b lunt hepatic trauma or iatrogenic injury. The majority of APF present withi n weeks to months of injury with gastrointestinal hemorrhage, hemobilia, ab dominal pain, and diarrhea. When presenting remotely APFs are associated wi th portal hypertension, heart failure, gastrointestinal hemorrhage, ascites , and splenomegaly. We report an unusual case of mesenteric ischemia due to an APF that resulted from a penetrating liver injury 20 years before prese ntation. Successful treatment of the APF was achieved by intravascular cath eter occlusion resulting in resolution of symptoms.