Severe Liver Injury Complicated by Portal Hypertension and Traumatic Arterioportal Shunt: A Case Report.

Background: Traumatic arterioportal (AP) shunts are rare vascular complications of hepatic trauma. In patients with severe liver injury, portal hypertension and hepatic dysfunction may develop during the postoperative course, and delayed AP shunts can be difficult to detect on computed tomography. Case Presentation: We report the case of a 19-year-old male who sustained a severe blunt liver injury in a motorcycle accident and presented with hemorrhagic shock. After initial surgical and endovascular hemostatic management, he developed progressive portal hypertension, worsening hepatic dysfunction, and persistent large-volume abdominal fluid. A multiphasic computed tomography scan performed on hospital day 32 showed no definite arterioportal shunt, although splenomegaly and gastrointestinal wall edema were present. On hospital day 39, angiography revealed an AP shunt between the right hepatic artery and the posterior branch of the portal vein. The shunt was treated with transcatheter arterial embolization, after which the patient showed gradual clinical improvement, including reduction of ascitic drainage and recovery of portal venous flow direction on follow-up ultrasonography. Conclusion: This case highlights that traumatic AP shunts may be identified during the course of severe liver injury with portal hypertension and hepatic dysfunction, even when computed tomography is initially negative. Angiography should be considered when delayed vascular complications are suspected, and timely embolization may contribute to clinical improvement.