Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Zhang YP, Lu Y, Wei HZ, Yang M, Liang B, He L, Zhao CB, Deng ZL, Wang JJ, Wang GQ, Wu HS, Yin T. Gastroduodenal arterioportal fistula: Two case reports and review of literature. World J Gastroenterol 2027; 33(2): 123953 [DOI: 10.3748/wjg.123953]
World J Gastroenterol. Jan 14, 2027; 33(2): 123953 Published online Jan 14, 2027. doi: 10.3748/wjg.123953
Gastroduodenal arterioportal fistula: Two case reports and review of literature
Yun-Peng Zhang, Yu Lu, Hong-Zhen Wei, Ming Yang, Bin Liang, Long He, Chuan-Bing Zhao, Zang-Long Deng, Jing-Jie Wang, Geng-Qiao Wang, He-Shui Wu, Tao Yin
Yun-Peng Zhang, Yu Lu, Hong-Zhen Wei, Ming Yang, Long He, Chuan-Bing Zhao, Zang-Long Deng, Jing-Jie Wang, Geng-Qiao Wang, He-Shui Wu, Tao Yin, Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430023, Hubei Province, China
Bin Liang, Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430023, Hubei Province, China
Co-first authors: Yun-Peng Zhang and Yu Lu.
Co-corresponding authors: He-Shui Wu and Tao Yin.
Author contributions: Zhang YP and Lu Y collected and analyzed the clinical data, reviewed the literature, and drafted the manuscript as co-first authors; Wei HZ, Yang M, He L, Zhao CB, Deng ZL, Wang JJ, and Wang GQ participated in the diagnosis and treatment of the patients, data collection, and patient follow-up; Liang B contributed to the interventional treatment and radiological evaluation and interpretation; Wu HS and Yin T jointly conceived and supervised the study, participated in the clinical management of the patients, and critically revised the manuscript; Wu HS and Yin T contributed equally as co-corresponding authors. All authors read and approved the final manuscript.
AI contribution statement: No AI tools were used during the preparation of this manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Tao Yin, Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430023, Hubei Province, China. ytwhun@hust.edu.cn
Received: June 2, 2026 Revised: July 21, 2026 Accepted: September 9, 2026 Published online: January 14, 2027 Processing time: 158 Days and 19.8 Hours
Abstract
BACKGROUND
Gastroduodenal arterioportal fistula (GDA-APF) is an extremely rare vascular malformation that commonly presents with unexplained upper gastrointestinal bleeding, abdominal pain, ascites, nausea, vomiting, diarrhea, and even congestive heart failure.
CASE SUMMARY
We report two cases of GDA-APF managed by distinct strategies dictated by lesion characteristics. In case 1, an incidentally detected fistula with a relatively well-defined vascular configuration - comprising a discrete aneurysmal cavity and an accessible draining vein - was cured by combined transarterial and transportal coil embolization with absolute ethanol sclerotherapy with no symptoms at 24 months. In case 2, a complex arterioportal fistula coexisting with a pancreatic arteriovenous malformation with failed transarterial embolization was cured by pancreaticoduodenectomy with no radiological recurrence at 24 months.
CONCLUSION
GDA-APF lacks specific signs. Treatment of choice should be determined by fistula anatomy and concomitant solid-organ pathology.
Core Tip: Gastroduodenal arterioportal fistula is an exceedingly rare vascular malformation with non-specific symptoms. Through two contrasting cases, we highlight that treatment should be individualized by fistula anatomy and coexisting solid-organ pathology rather than a rigid “intervention-first” rule. Anatomically simple lesions with an accessible draining vein are curable by combined transarterial and transportal embolization, whereas complex, multi-fed fistulas with pancreatic arteriovenous malformation warrant upfront pancreaticoduodenectomy.
