Giant Congenital Arterioportal Fistula Presenting as Variceal Bleeding in an Adult

A 27-year-old man with no medical history presented abdominal pain and hematemesis. The physical examination on arrival showed right flank tenderness a blood pressure of 92/59 mm Hg heart rate 139 beats per minute. Pertinent laboratory values were normal except for hemoglobin level 10.2 g/dL. patient underwent an emergent esophagogastroduodenoscopy, which esophageal gastroesophageal varices active bleeding treated by band ligation glue injection, respectively. subsequent computed tomography scan ascites associated enlargement hepatic arterial portal venous systems (Figure A, asterisk arrows). latter was highlighted at the phase, strongly suggesting existence arterioportal communication. An angiogram performed confirming giant intrahepatic shunting B). These findings consistent presinusoidal hypertension–related variceal caused fistula. It closed successfully catheter-directed embolization using large Amplatzer Vascular Plug II (Abbott Vascular, Chicago, IL) C). No further early vein enhancement seen during arteriogram. Recovery uneventful 6-month follow-up evaluation. There have been only few cases congenital fistula–related hemorrhage reported in adults. Informed consent obtained from publication information imaging.