Mesenteric arteriovenous fistula causing portal hypertension and bleeding duode...

• Author(s): Baranda, J ; Pontes, JM ; Portela, F ; Silveira, L ; Amaro, P ; Ministro, P ; Rosa, A ; Pimenta, I ; Andrade, P ; Bernardes, A ; Pereira, J ; Leitão, M ; Donato, A ; Freitas, D
• Date: 1996
• Persistent ID: http://hdl.handle.net/10400.4/580
• Origin: Repositório do Centro Hospitalar e Universitário de Coimbra
• Subject(s): Hemorragia Gastrointestinal; Hipertensão Portal; Fístula Arteriovenosa; Artéria Mesentérica Inferior
• Document Type: Article
• Language: English

Description

We report a case of portal hypertension associated with a non-traumatic arteriovenous fistula, presenting with bleeding duodenal varices. The patient was admitted for melaena. Emergency endoscopy showed oesophageal varices with no signs of recent bleeding and with no blood in the upper gastrointestinal tract. Arteriography of the coeliac axis and superior mesenteric artery failed to detect any bleeding source. Endoscopy was repeated because of persistent bleeding and revealed active bleeding from varices in the distal duodenum. The patient underwent surgery and a large paraduodenal varicose vein associated with an arteriovenous fistula was found. Resection of the paramural varix and surgical occlusion of the arteriovenous fistula were effective in the control of bleeding. Liver biopsy revealed mild portal fibrosis without cirrhosis. Three years after surgery the patient still has oesophageal varices but has not had recurrent bleeding. There was regression of intraduodenal varices.