Splenic Arteriovenous Fistula Causing Massive Ascites: A Case Report

Abstract

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.

Embolization of a giant arterioportal fistula requiring multiple Amplatzer vascular plugs

“…APF formation after visceral artery aneurysm rupture, often in the setting of pregnancy, is an alternative precipitating event and possibly the etiology in this patient. 3 Type 2 APFs are larger extrahepatic fistulas that produce elevated portal pressures and can lead to hepatoportal sclerosis and portal fibrosis. 2 In our case, it was thought that the APF was so large that spontaneous thrombosis was unlikely and that the previously described histologic changes of fibrosis, sinusoidal dilation, and necrotizing periportal vasculitis would progress and inevitably result in eventual symptoms.…”

Duplex Doppler findings in splenic arteriovenous fistula

“…The diagnosis is generally made only after 2 or more hospital admissions. [3][4][5] This delay exposes patients to the risks of death from severe gastrointestinal bleeding and of intrahepatic sclerosis, which can eventually lead to irreversible portal hypertension, even if the AVF is removed. 6 An early diagnosis is therefore crucial.…”

Posttraumatische arteriovenöse Fistel zwischen Arteria und Vena lienalis als seltene Ursache akuter Myokardischämie

“…In letzterem Fall kommen neben Rupturen congenitaler oder mykotischer Aneurysmen der A. lienalis traumatische (meist nach Perforationsverletzungen) oder iatrogene Ursachen (vorwiegend nach Splenektomie) in Betracht [1,13]. Vorstellbar wa È re auch eine iatrogene Entstehung im Rahmen der Notsplenektomie mit Massenligaturen und Induktion einer lokalen Pankreatitis und Andauung der Gefa Èûe [4,20]. Vorstellbar wa È re auch eine iatrogene Entstehung im Rahmen der Notsplenektomie mit Massenligaturen und Induktion einer lokalen Pankreatitis und Andauung der Gefa Èûe [4,20].…”

“…¹high-output cardiac failureª, zu verhindern [16,19,20]. Zuna È chst dominierten Oberbauchdauerschmerzen, spa È ter progrediente und nicht mehr beherrschbare, kolikartige Beschwerden mit zuletzt Durchfa È llen, U È belkeit und Erbrechen ± Symptome a È hnlich einer Angina abdominalis, welche durch die veno È se Stauung des Darms erkla È rt werden ko È nnen.…”