Case Report
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World J Gastroenterol. Nov 28, 2012; 18(44): 6501-6503
Published online Nov 28, 2012. doi: 10.3748/wjg.v18.i44.6501
Gastrointestinal bleeding caused by extrahepatic arterioportal fistula associated with portal vein thrombosis
Ling Nie, Xue-Feng Luo, Xiao Li
Ling Nie, Laboratory of Pathology, Department of Pathology, State Key Laboratoty of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Xue-Feng Luo, Xiao Li, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Xue-Feng Luo, Xiao Li, Center for Vascular and Liver Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Nie L and Luo XF wrote the manuscript; Li X performed the procedure and revised the paper.
Supported by National Nature Science Foundation of China, No. 307709848 and No. 81171444
Correspondence to: Xiao Li, MD, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. simonlixiao@126.com
Telephone: +86-28-88092354 Fax: +86-28-88092354
Received: July 22, 2012
Revised: September 3, 2012
Accepted: September 12, 2012
Published online: November 28, 2012
Abstract

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.

Keywords: Extrahepatic arterioportal fistula, Portal vein thrombosis, Embolization, Transjugular intrahepatic portosystemic shunt