Dušan GRUJİĆ, Aleksandar KNEŽEVİĆ, Svetlana VOJVODİĆ, Bojana GRUJİĆ

125127

Superior Mesenteric Arteriovenous Fistula Presenting with Massive Lethal Upper Gastrointestinal Bleeding 14 Years after Small Bowel Resection

Superior Mesenteric Arteriovenous Fistula Presenting with Massive Lethal Upper Gastrointestinal Bleeding 14 Years after Small Bowel Resection

Background: Arteriovenous fistulas (AVFs) of the superior mesenteric vasculature are rarely encountered. We present a case of an iatrogenic superior mesenteric AVF in a patient who had undergone a small bowel resection 14 years previously. Case Report: The 45-year-old male was admitted with bloody diarrhea, fatigue, weight loss and moderate ascites. On the fifth hospital day, while being evaluated for suspected liver cirrhosis, the patient developed severe gastrointestinal (GI) bleeding. An upper GI endoscopy revealed bleeding, esophago-gastric varices. A thorough clinical examination pointed to a paraumbilical murmur and thrill, while a contrast enhanced computerized tomography (CT) scan of the abdomen revealed the presence of cystic dilatation of the superior mesenteric vein (SMV), hepatomegaly and ascites. Duplex ultrasonography and 3D-computed tomography angiography (3D-CTA) confirmed the existence of AVF between the superior mesenteric artery (SMA) and SMV, which was the cause of portal hypertension and variceal bleeding. Despite the fact that AVF was ultimately recognized, uncontrollable hypovolemic shock caused by hematemesis, precluded the probable efficiency of further therapeutic attempts. Conclusion: Successful management of mesenteric blood vessel AVFs involves timely and the accurate diagnosis and early treatment in order to prevent the development of life threatening complications.
Keywords:

Iatrogenic arteriovenous fistula, portal hypertension, superior mesenteric artery, variceal bleeding,

PDF

___

  • 1. Kato S, Nakagawa T, Kobayashi H, Arai E. Superior mesenteric arteriovenous fistula: report of a case and review of the literature. Surg Today 1993;23:73-7. [CrossRef]
  • 2. Van Way CW 3rd, Crane JM, Riddell DH, Foster JH. Arteriovenous fistula in the portal circulation. Surgery 1971;70:876-90.
  • 3. Xu CE, Guo L, Li GX, Zhang SG, Yu ZH, Ruan CL. A rare case of superior mesenteric arterio-venous fistula causing jejunal varices and recurrent GI bleeding. EJVES Extra 2006;12:35-7. [CrossRef]
  • 4. Hussein M, Issa G, Muhsen S, Haydar A. Superior mesenteric arteriovenous fistula embolisation complicated by bowel ischaemia. BMJ Case Rep 2013;2013.
  • 5. Temin N N, Flacke S, Ahari H K. Superior Mesenteric Arteriovenous Fistula Imaging Findings and Endovascular Treatment. Vasc Endovascular Surg 2012;46:675-8. [CrossRef]
  • 6. Shintani T, Mitsuoka H, Masuda M. Transcatheter coil embolization of an iatrogenic superior mesenteric arteriovenous fistula: report of a case. Surg Today 2011;41:556-9. [CrossRef]
  • 7. Bratton C F, Hamid A, Selby J B, Baliga P K. Case report: gastrointestinal hemorrhage caused by a pancreas transplant arteriovenous fistula with large psuedoanuerysm 9 years after transplantation. Transplant Proc 2011;43:4039-43. [CrossRef]
  • 8. Buttarelli L, Capocasale E, Marcato C, Mazzoni M P, Iaria M, Rossi C. Embolization of pancreatic allograft arteriovenous fistula with the Amplatzer vascular plug 4: case report and literature analysis. Transplant Proc 2011;43:4044-47. [CrossRef]
  • 9. Diehl J T, Beven E G. Arteriovenous fistulas of the mesenteric vessels. Report of a case and review of the literature. J Cardiovasc Surg (Torino) 1982;23:334-7.
  • 10. Popović DDj, Spuran M, Davidović L, Alempijević T, Ugljesić M, Banzić I, et al. Portal hypertension caused by postoperative superior mesenteric arteriovenous fistula. Vojnosanit Pregl 2012;69:623-6. [CrossRef]
  • 11. Durham M W, Robnett A H, Harper H P, Yekel R. Arteriovenous fistula of the mesenteric vessels. West J Surg Obstet Gynecol 1962;70:9-11.
  • 12. Wong KK, Wong JSW, Tso WK, Tai KS. Superior Mesenteric Arteriovenous Fistula: an Unusual Cause of Ascites. J HK Coll Radiol 2007;10:77-80.
  • 13. Eiberg JP, Bundgaard-Nielsen M, Hansen MA, Secher NH. Endovascular repair of iatrogenic superior mesenteric arteriovenous fistula. EJVES Extra 2009;17:21-3. [CrossRef]
  • 14. Mick SL, Bush HL Jr, Barie PS. Superior mesenteric arteriovenous fistula causing massive hematemesis. Surgery 2003;134:102-4. [CrossRef]
  • 15. Ba-ares R, Albillos A, Rincón D, Alonso S, González M, Ruizdel-Arbol L, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta-analysis. Hepatology 2002;35:609-15. [CrossRef]
Balkan Medical Journal-Cover
  • ISSN: 2146-3123
  • Başlangıç: 2015
  • Yayıncı: Erkan Mor
Arşiv
Sayıdaki Diğer Makaleler

Characterization of the Interleukin-28B Gene rs12979860 C/T Polymorphism in Turkish Chronic Hepatitis C Patients and Healthy Individuals

Serpil TAHERİ, Halit CANATAN, Bilgehan AYGEN, Orhan YILDIZ, Keziban KORKMAZ, Gökmen ZARARSIZ

Superior Mesenteric Arteriovenous Fistula Presenting with Massive Lethal Upper Gastrointestinal Bleeding 14 Years after Small Bowel Resection

Dušan GRUJİĆ, Aleksandar KNEŽEVİĆ, Svetlana VOJVODİĆ, Bojana GRUJİĆ

BRAFV600E Mutation, RET/PTC1 and PAX8-PPAR Gamma Rearrangements in Follicular Epithelium Derived Thyroid Lesions - Institutional Experience and Literature Review

Ahmet ŞAHPAZ, Binnur ÖNAL, Ahmet YEŞİLYURT, Ünsal HAN, Tuncay DELİBAŞI

Alcohol is not Safe even at Light Amounts

Aslı Ceren TAHAN, Veysel TAHAN

Clinical Implications of Nasal Septal Deformities

Ranko MLADİNA, Neven SKİTARELİĆ, Gorazd POJE, Marin ŠUBARİĆ

New Predictive Parameters of Bell"s Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio

Doğan ATAN, Aykut İKİNCİOĞULLARI, Kürşat Murat ÖZCAN, Sabri KÖSEOĞLU