Unique de novo presentation of blunt liver trauma: Multiple small intra-hepatic arterioportal fistulas

Post-traumatic arterioportal fistulas are usually large and single to few in number. Mechanism of arterioportal shunt in traumatic settings is primarily due to direct hepatic artery to portal vein communication. A unique case of multiple and small arterioportal fistulas related to blunt abdominal trauma without capsular or biliary radical involvement is presented. The mechanism of this finding is probably due to microscopic mechanical disruption of the liver parenchyma. Shunting was successfully treated with selective gelfoam embolization of the hepatic artery branch. Post-traumatic arterioportal fistulas could be the only manifestation to blunt liver trauma representing an early stage of liver trauma ahead of CT-based Injury Severity of Blunt Hepatic Trauma stages. Minimal intervention has a role in safely managing this condition and averting long-term sequelae.