title: Gastrointestinal bleeding caused by extrahepatic arterioportal fistula associated with portal vein thrombosis.
abstract: An extrahepatic arterioportal fistula (APF) involving the gastroduodenal artery and superior mesenteric vein is rare and mostly results from iatrogenic injuries. The clinical symptoms associated with APFs may include abdominal pain, gastrointestinal bleeding, ascites, nausea, vomiting, diarrhea, or even congestive heart failure. We present the case of a 70-year-old man who presented with chronic abdominal pain and gastrointestinal bleeding secondary to APF and portal vein thrombosis. The endovascular embolization of APF was accomplished successfully, and symptoms of portal hypertension resolved immediately after intervention. Unfortunately, the patient did not respond well to anticoagulation therapy with warfarin. Therefore, the patient underwent implantation of a transjugular intrahepatic portosystemic shunt, and the complications of portal hypertension resolved. In conclusion, the embolization of APF is technically feasible and effective and can be considered the first-choice therapy in selected patients.
authors.affiliation: Laboratory of Pathology, Department of Pathology, State Key Laboratoty of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Nie
authors.forename: Xue-Feng
authors.initials: XF
authors.lastname: Luo
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000783:Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000925:Anticoagulants / Q000627:therapeutic use; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D010690:Phlebography / Q000379:methods; D011169:Portal Vein / Q000000981:diagnostic imaging; D011170:Portasystemic Shunt, Surgical; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin