Open AccessRectal arterio-portal fistula: An unusual cause of persistent bleeding per rectum following a proximal spleno-renal shunt
Author(s) -
Hao Yun Yap,
Ser Yee Lee,
Y. F. A. Chung,
Kiang Hiong Tay,
Albert Low,
Choon Hua Thng,
Krishnakumar Madhavan
Publication year - 2013
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.v19.i25.4087
Subject(s) - medicine , portal hypertension , fistula , inferior mesenteric vein , radiology , portal vein thrombosis , portal venous system , portal venous pressure , gastrointestinal bleeding , surgery , splenic artery , rectum , portosystemic shunt , embolization , splenectomy , arteriovenous fistula , thrombosis , portal vein , cirrhosis , spleen
Gastrointestinal arterio-venous malformations are a known cause of gastrointestinal bleeding. We present a rare case of persistent rectal bleeding due to a rectal arterio-portal venous fistula in the setting of portal hypertension secondary to portal vein thrombosis. The portal hypertension was initially surgically treated with splenectomy and a proximal splenorenal shunt. However, rectal bleeding persisted even after surgery, presenting us with a diagnostic dilemma. The patient was re-evaluated with a computed tomography mesenteric angiogram which revealed a rectal arterio-portal fistula. Arterio-portal fistulas are a known but rare cause of portal hypertension, and possibly the underlying cause of continued rectal bleeding in this case. This was successfully treated using angiographic localization and super-selective embolization of the rectal arterio-portal venous fistula via the right internal iliac artery.The patient subsequently went on to have a full term pregnancy. Through this case report, we hope to highlight awareness of this unusual condition, discuss the diagnostic workup and our management approach.