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BACKGROUND: Most intrahepatic arterioportal fistulae (IAPF) are acquired. The few cases of congenital fistulae are diagnosed in infants and children. CASE SUMMARY: We report a 31-year-old female patient presenting with haematemesis and melena three weeks after delivering her second child. The patient had a 20-year history of abdominal distention and nausea. IAPF, along with splenomegaly and ascites, was found by Doppler sonography and confirmed by computed tomography angiography. The patient was treated with endovascular coil embolization, resulting in occlusion of the fistula. CONCLUSION: This was an unusual case of possible congenital IAPF that manifested during a second pregnancy and was complicated by portal hypertension.
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INTRODUCTION: Perforation is a dangerous complication of peptic ulcer disease and requires emergency surgical treatment. In recent decades laparoscopic repair of duodenal perforation has been widely used in emergency abdominal surgery. AIM: To analyze laparoscopic and open surgical treatment of 120 consecutive patients with perforated duodenal ulcer. MATERIAL AND METHODS: The study included a group of 120 consecutive patients, operated on for perforated duodenal ulcer in a single institution. Laparoscopic or open repair with or without an omental patch was performed. The value of the Boey score was investigated in predicting the outcomes of treatment in the entire study group. RESULTS: In 61 (50.8%) cases open repair was performed, in 56 (46.7%) cases laparoscopic repair, and in 3 (2.5%) cases conversion was performed. In the laparoscopy group the mean hospital stay was 5 days (range: 3-14), in the open group 11.7 days (range: 6-63), and in the conversion group 9.3 days (8-10) (p < 0.001). There was a significant difference between characteristics of patients in the laparoscopic groups: in the second period of laparoscopic procedures (2014-2017) the duration of the operation was significantly shorter and the number of postoperative complications was significantly lower than in the initial study group (2010-2013). CONCLUSIONS: The laparoscopic approach is an effective method for treatment of perforated duodenal ulcer in selected cases. A number of 20-25 cases for the surgeon operating with the laparoscopic method is sufficient to achieve an acceptable level of expertise. More prospective randomized studies are needed to evaluate the effectiveness of laparoscopic repair of perforated duodenal ulcer.