Melena-associated regional portal hypertension caused by splenic arteriovenous fistula

Regional portal hypertension is a rare cause of upper gastrointestinal bleeding. We reported an extremely rare case in which regional portal hypertension was associated with both the splenic arteriovenous fistula and chronic pancreatitis. In June 2010, our patient, a 41-year-old man, was admitted to a local hospital due to a sudden melena and dizziness without haematemesis and jaundice. The splenic arteriovenous fistula in this patient was successfully occluded through transcatheter arterial embolization. At the 12-mo follow-up, our patient was in good condition.     

Aortocaval fistula: diagnosis and treatment: case studies

Two cases of aortocaval fistula were treated successfully with prompt surgical repair and dacron graft insertion in place of the abdominal aortic aneurysm. The first case presented here displayed signs and symptoms characteristic of aortocaval fistula, the second case displayed signs and symptoms characteristic of a ruptured abdominal aortic aneurysm. The lack of symptoms of arteriovenous fistula in the second case was due to occlusion of the fistula by laminated clots. The post-operative course of the second case was complicated by an acute renal failure which improved after medical treatment.     

Arterioportal Fistula: a Rare Cause of Portal Hypertension and Abdominal Pain

Esophageal varices are commonly caused by portal hypertension secondary to cirrhosis. We report the case of a 71-year-old woman who presented with esophageal variceal bleeding due to portal hypertension caused by an arteriovenous fistula. The fistula, which was probably brought about by a liver biopsy performed 18 years previously, was complicated by bleeding. Since this event, the patient has reported right upper quadrant pain. Embolization resulted in elimination of the varices as well as abdominal discomfort.     

Arterioportal fistula: a rare cause of portal hypertension and abdominal pain.

Esophageal varices are commonly caused by portal hypertension secondary to cirrhosis. We report the case of a 71-year-old woman who presented with esophageal variceal bleeding due to portal hypertension caused by an arteriovenous fistula. The fistula, which was probably brought about by a liver biopsy performed 18 years previously, was complicated by bleeding. Since this event, the patient has reported right upper quadrant pain. Embolization resulted in elimination of the varices as well as abdominal discomfort.     

Calcified splenic abscess, colonic fistula and ascites in a chronic carrier of Salmonella typhi

We report the unusual case of a patient with chronic carriage of Salmonella typhi who presented with partially calcified splenic abscess linked to colic fistula and ascitis. The colic fistula could be secondary to ischemic necrosis by left colon compression due to spleen large abscess. Fistula was evidenced by abdominal computed tomography scan and confirmed by barium enema. The possible etiologies of ascitis are either tuberculosis or ascitic peritonitis secondary to the fistulisation; nevertheless, the role of segmentary portal located hypertension cannot be completely excluded. The splenic abscess was probably due to Salmonella typhi which was only isolated from stool specimens. The calcified splenic abscess was the evidence that the infection had occurred first. In addition, the isolation of Salmonella typhi in stool cultures six months after the subject had returned from the Comores proved the chronic carriage. Treatment by splenectomy and left colectomy was successful in this patient.     

Endovascular repair of an aorto-left renal vein fistula due to a ruptured abdominal aortic aneurysm after EVAR.

PURPOSE: To report an unusual late complication of endovascular aneurysm repair: an arteriovenous fistula between the aneurysm sac and a retro-aortic left renal vein following sac expansion due to a type III endoleak. CASE REPORT: A 79-year-old man developed an arteriovenous fistula between the aneurysm sac and a retro-aortic left renal vein 67 months after endovascular aneurysm exclusion (EVAR). Aneurysm rupture was due to disconnection between the right iliac limb and an extender cuff. The problem was repaired percutaneously with another endograft bridging the two prostheses. At 16 months, the aneurysm sac diameter was decreased; there was no evidence of the AV fistula, and the patient was free from any complication related to the EVAR. CONCLUSIONS: This case emphasizes the need of close surveillance even in the late postoperative course of these patients. Moreover, this rare event confirmed that endovascular techniques can play an important role in treating emergent complications.     

Remission of heart failure through endoluminal repair of femoral arteriovenous fistula with the use of a covered stent

We report the case of a 21-year-old male with high-output heart failure due to a femoral arteriovenous fistula caused by a firearm wound. A new balloon expandable stent covered with polytetrafluorethylene was implanted in the artery to occlude the arteriovenous fistula. The fistula was immediately occluded and the artery remained patent. On the following day, the patient felt much better, with no symptoms of heart failure. Additional follow-up is required to assure the usefulness of this less invasive procedure in the treatment of arteriovenous fistulas.     

Portal Hypertension Secondary to a Spontaneous Splenic Arteriovenous Fistula: Case Report and Review of the Literature

A 66-yr-old woman developed diarrhea, abdominal pain, and ascites which was subsequently discovered to be secondary to portal hypertension resulting from a splenic arteriovenous fistula. Splenectomy resulted in reduction of the portal pressure and resolution of the patient's symptoms. The literature pertaining to splenic arteriovenous fistulas with portal hypertension is discussed.     

Inferior mesenteric arteriovenous fistula: Case report and world-literature review

Arteriovenous fistulas between the inferior mesenteric artery and vein are rare, with only 26 primary and secondary cases described in the literature. Secondary fistulas occur following operations of the left hemicolon and manifest as abdominal pain, abdominal mass, gastrointestinal bleeding, colonic ischemia and portal hypertension. Symptom intensities are flow-dependent, and can range from minimal symptoms to severe heart failure due to left to right shunt. Diagnosis is usually established by radiological or intraoperative examination. Treatment options include embolization and/or surgical resection. Therapeutic decisions should be adapted to the unique characteristics of the fistula on an individual basis. A new case of a primary arteriovenous fistula is described and discussed along with a complete review of the literature. The patient in this report presented with signs and symptoms of colonic ischemia without portal hypertension. The optimal treatment for this patient required a combination of embolization and surgical operation. The characteristics of these rare inferior mesenteric arteriovenous fistulas are examined and some considerations concerning diagnostic and therapeutic strategies that should be followed are presented.     

Splenic arteriovenous fistula causing massive ascites: a case report

A case of splenic arteriovenous fistula leading to portal hypertension and ascites is presented. The recognition of this vascular lesion is important. When portal hypertension is secondary to a splenic arteriovenous fistula, the complications of portal hypertension can be avoided by the resection of the lesion. The diagnosis can be suspected by clinical findings and confirmed by angiographic delineation of the fistula. Surgical resection of splenic arteriovenous fistulae must include the fistula and all dilated venous tributaries to prevent thrombosis and recurrent portal hypertension.     

A rare case of hemothorax due to rupture of an arteriovenous fistula: successful treatment by enucleation]

Hemothorax due to a rupture in an arteriovenous fistula is rare. We report a case in a 26-year-old woman who presented with continuous right chest pain. On admission, chest radiography revealed a nodular shadow in the right lower lung field with right pleural effusion. The pleural effusion aspirated was blood, suggesting a hemothorax due to the rupture of a pulmonary arteriovenous fistula. The shunt between A 8 and V 8 was confirmed in pulmonary arteriograms. A photomicrograph of the resected specimen showed a dilated arteriovenous fistula, part of whose inner wall was abnormally thin. The pleural wall surrounding the fistula was hypertrophic in parts, suggesting possible repetitive inflammation related with the rupture. Although transcatheter embolization is useful in the treatment of arteriovenous fistulae, it is technically difficult, and cases of fatal complications have been reported. While surgical resection is the most reliable treatment available, the present patient was already at high risk of dying. Accordingly, we chose to perform enucleation, and this was successful.     

Ulcers associated with arteriovenous fistula within a Stewart-Bluefarb syndrome: arterial and/or venous therapy?

We report on a 46-year old female patient with a 2-year history of ulceration over the dorsum of her right foot associated with a congenital arteriovenous fistula. About 12 years ago she had an ulcer at the same site. Despite an insufficient occlusion of the arteriovenous fistula after coil-embolization complete healing of the ulcer was achieved for a period of 10 years. At present hyperpigmentation could be seen surrounding the ulcer as a clinical sign for a venous insufficiency. The ulcer healed completely under a conservative therapy of the venous component of the arteriovenous fistula. The pathogenesis and therapy of ulcers associated with arteriovenous fistula within a Stewart-Bluefarb syndrome are discussed in this case report.     

Rare case of pulmonary arteriovenous fistula simulating residual defect after transcatheter closure of patent foramen ovale for recurrent paradoxical embolism.

We report on a patient suffering from recurrent cerebrovascular events despite previous transcatheter closure of persistent foramen ovale (PFO) with a Helex occluder. There was evidence of persistent left-to-right atrial shunt shown by transesophageal contrast echocardiography and the patient was admitted to our institution for interventional closure of the supposed residual defect. However, the PFO was completely closed by the device and left pulmonary artery injections showed a pulmonary arteriovenous fistula in the left lower lobe. This rare malformation may well explain the recurrent paradoxical embolism. Transcatheter fistula closure with coils was performed successfully. This case underlines that the existence of an isolated pulmonary arteriovenous fistula as a right-to-left shunt in patients with cryptogenic stroke should not be overlooked, even if a PFO is present and pulmonary arteriovenous fistula is not suggested by the initial physical findings or chest X-ray.     

Transcatheter Closure of a Peripheral Arteriovenous Fistula: A Unique Use of a Covered Stent in a Child with Complex Congenital Heart Disease

Introduction. This report describes the use of a covered stent to occlude a surgical arteriovenous fistula in a child with complex cyanotic heart disease. Method. A single case report. Results. An Atrium iCAST covered stent was delivered percutaneously to the left axillary artery in an 8‐year‐old child with a failing single‐lung Fontan who had undergone the creation of a surgical axillary arteriovenous fistula to augment pulmonary blood flow. The covered stent completely occluded the fistula, without complications or compromise of arterial flow to the upper extremity. The patient subsequently experienced significant improvement in peripheral edema, ascites and pleural effusions. Conclusion. Although a single case report, this experience suggests a potentially important role for covered stents in the management of children with complex congenital heart disease.     

Inferior mesenteric arteriovenous fistula associated with portal hypertension and acute ischemic colitis. Successful occlusion by intraarterial embolization with steel coils

The authors report a case of postoperative arteriovenous fistula between the inferior mesenteric vessels. This fistula was revealed by portal hypertension, with bleeding esophageal varices, ascites, and encephalopathy, and by acute ischemic colitis. Histologic examination of the liver was normal. All of the symptoms disappeared after transcatheter embolization of the fistula with stainless steel coils. This case report favors the reality of the so-called "forward" portal hypertension and suggests that inferior mesenteric arteriovenous fistula might be a factor predisposing to nonocclusive ischemic colitis.     

Primary aortoenteric fistula

Primary aortoenteric fistula is a rare complication of aortic aneurysms. This cause of gastrointestinal bleeding poses significant diagnostic challenges due to its nonspecific presentation. We report a case of an 80-year-old man with right flank pain and rectal bleeding. The patient had been admitted 2 weeks before with the same symptoms. Upper and lower endoscopies were unremarkable, but abdominal computed tomography scan showed evidence of aortoduodenal fistula. An emergency laparotomy with aortic bypass and fistula closure was performed and the patient was able to recover in the following weeks. This case highlights the need for a high index of suspicion to avoid diagnostic delay that frequently has fatal results.     

Giant renal aneurysm with arteriovenous fistula

A hypertensive 78-year-old woman was admitted with continuous abdominal pain and nausea and was diagnosed with right giant renal artery aneurysm (RAA; 70 mm in diameter) by means of abdominal computed tomography. Aortography demonstrated huge RAA with arteriovenous fistula visualizing the inferior vena cava at arterial phase. Nephrectomy was performed and the patient has had an uneventful postoperative course.     

Unilateral Proptosis (Exophthalmos) Caused by Axillary-Subclavian Venous Thrombosis in a Patient with Upper Extremity Arteriovenous Dialysis Fistula

Arterialization of orbital veins is most often due to dural arteriovenous malformations of the cavernous sinus area. We report an unusual case of unilateral proptosis (exophthalmos) caused by arterialized retrograde venous flow in the external jugular vein and cavernous sinus in a patient with an upper extremity hemodialysis fistula and ipsilateral acute central venous thrombosis. The patient’s symptoms improved after surgical closure of the hemodialysis fistula.     

Non hypoxia-related splenic infarct in a patient with sickle cell trait and infectious mononucleosis

Splenic infarction in patients with sickle cell trait is usually related to hypoxic conditions, while non-hypoxia-related infarcts are extremely rare. We report on a case of a 17-year-old male patient, living at sea level, who developed a severe left upper quadrant abdominal pain during the course of a febrile episode. On physical examination he had a mildly palpable but extremely painful spleen. A spleen scan revealed 2 areas of impaired radionucleide distribution. Hepatic enzymes were moderately increased and the IgM anti-EBV antibodies positive. Hemoglobin electrophoresis revealed the presence of 42% of hemoglobin S. A probable diagnosis of splenic infarction was established in a patient with sickle cell trait, during the course of infectious mononucleosis. The patient was treated symptomatically. The conditions of splenic congestion induced by the EBV infection and the high-grade fever may have contributed to splenic sequestration and subsequent infarcts.     

Splenic abscess in the course of infective endocarditis--report of a case

Infective endocarditis is the most common condition predisposing a patient to splenic abscess. We report the case of man aged 65 who was admitted to the Internal Medicine Department to diagnose the fever of unknown origin. The fever lasted longer than one year. Clinical status and executed diagnostics, among others: echocardiography, blood cultures, abdominal ultrasonography, abdominal computed tomography allowed to give the diagnosis splenic abscess caused by Acinetobacter Baumanii in the course of infective endocarditis. Patient was treated by splenectomy and antibiotics. As a result of the treatment normalization of temperature and recovery was obtained.