[Inversion of intraheptic portal flow in contusions of the liver: a new concept of traumatic arterioportal fistulas (author's transl)].

Inversion of the intrahepatic flow is a phenomenon commonly observed during the initial days of a liver contusion. Its symptomatology combines one direct sign: segmentary, peripheral arterioportal reflux; and two indirect signs: arteriolar hypervascularization and a functional amputation of portal flow on selective arteriography of the superior mesenteric artery in the same territory. The direct sign may be absent, and may not be visualized in the absence of a selective injection. Both indirect signs are always present and enable the diagnosis. In most cases it is a question of a transient phenomenon secondary to a inflammatory reaction released by the contusion of the liver parenchyma; it may be the only sign of liver trauma. It may be a sign of a benign contusion and is not alone an indication for surgery. This concerns a hemodynamic phenomenon which must be clearly differentiated from arterioportal fistulas with which it is often confused.