Open AccessGastrointestinal bleeding caused by extrahepatic arterioportal fistula associated with portal vein thrombosis
Author(s) -
Ling Nie,
Xuefeng Luo,
Xiao Li
Publication year - 2012
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v18.i44.6501
Subject(s) - medicine , portal vein thrombosis , gastrointestinal bleeding , portal hypertension , abdominal pain , transjugular intrahepatic portosystemic shunt , surgery , embolization , ascites , radiology , nausea , vomiting , fistula , thrombosis , arteriovenous fistula , cirrhosis
An extrahepatic arterioportal fistula (APF) involving the gastroduodenal artery and superior mesenteric vein is rare and mostly results from iatrogenic injuries. The clinical symptoms associated with APFs may include abdominal pain, gastrointestinal bleeding, ascites, nausea, vomiting, diarrhea, or even congestive heart failure. We present the case of a 70-year-old man who presented with chronic abdominal pain and gastrointestinal bleeding secondary to APF and portal vein thrombosis. The endovascular embolization of APF was accomplished successfully, and symptoms of portal hypertension resolved immediately after intervention. Unfortunately, the patient did not respond well to anticoagulation therapy with warfarin. Therefore, the patient underwent implantation of a transjugular intrahepatic portosystemic shunt, and the complications of portal hypertension resolved. In conclusion, the embolization of APF is technically feasible and effective and can be considered the first-choice therapy in selected patients.