Delayed Presentation of Arterioportal Hepatic Fistula in the Absence of Portal Hypertension: A Case Report

An arterioportal hepatic fistula (APF) is an abnormal vascular communication between a branch of the hepatic artery and the portal vein.APFs most often occur secondary to trauma but can present due to hepatic procedures, abdominal neoplasm, or congenital malformation.APFs are often asymptomatic due to being small in size and located in anatomically insignificant areas.Large or centrally located APFs often present with portal hypertension, hemorrhage, or hepatic dysfunction.This case report describes a 79-yearold woman who developed a symptomatic centrally located APF without portal hypertension sequelae after a liver biopsy.The incidence, pathophysiologic mechanisms, presentation, diagnosis, and management are discussed.