# Case Report: Intrahepatic arterioportal fistula (IAPF)—a rare cause of hemobilia

## TL;DR

This case report describes a rare instance of biliary bleeding caused by an intrahepatic arterioportal fistula in an elderly woman and highlights the role of imaging in diagnosis and treatment.

## Contribution

The novelty lies in presenting a rare cause of hemobilia and demonstrating the effectiveness of imaging and embolization in managing it.

## Key findings

- Intrahepatic arterioportal fistula was identified as the cause of hemobilia through CT and MRCP imaging.
- Transcatheter arterial embolization successfully treated the fistula and stopped the bleeding.
- The case emphasizes the diagnostic value of imaging in complex biliary diseases in elderly patients.

## Abstract

Intrahepatic arterioportal fistula is a rare vascular malformation, and cases of hemobilia due to it are extremely rare. This article reports a rare case of hemobilia due to intrahepatic arterioportal fistula in an elderly woman. Upon admission, the patient presented with sporadic upper abdominal pain lasting 3 days. The initial diagnosis of choledocholithiasis was made following a review of the upper abdominal Computed Tomography (CT) scan from a previous hospital and our hospital's Magnetic Resonance Cholangiopancreatography (MRCP). Hemobilia and sedimentary clot were identified during ERCP microscopy. Post-ERCP imaging, specifically CT enhancement, revealed an intrahepatic arterioportal fistula. This finding, in conjunction with insights from a multidisciplinary consultation, led to treatment via transcatheter arterial embolization (TAE). The patient recovered well postoperatively with cessation of bleeding. This case demonstrates IAPF as a rare cause of biliary bleeding and the diagnostic value of imaging for IAPF, which provides reference for the diagnosis and treatment of complex biliary diseases in elderly patients.