We report a case of severe portal hypertension due to a post-traumatic hepatic arterioportal fistula. A 77-year-old male patient was admitted for abdominal pain, inappetence and weight loss. Further clinical signs were ascites and splenomegaly. Sonography showed a marked enlargement of an arterioportal fistula, which was diagnosed some years before as a consequence of abdominal trauma during the Second World War. Angiography demonstrated an imposing dilatation of the right hepatic artery filling an intrahepatic pseudoaneurysmatic cavity with fistula formation to the portal vein. By means of selective hepatic artery embolization, complete occlusion of the right hepatic artery and the arterioportal fistula was achieved. Within 4 weeks the patient recovered and sonography showed disappearance of ascites and splenomegaly.