title: Superior Mesenteric Arteriovenous Fistula Presenting with Massive Lethal Upper Gastrointestinal Bleeding 14 Years after Small Bowel Resection.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia.
authors.forename: Dušan
authors.initials: D
authors.lastname: Grujić
authors.affiliation: Department of Internal Medicine, Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Knežević
authors.affiliation: Department of Laboratory Diagnostics, Institute for Blood Transfusion of Vojvodina, University of Novi Sad Faculty of Medicine, Novi Sad, Serbia.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Vojvodić
authors.affiliation: Department of Anesthesia and Intensive Therapy, Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia.
authors.forename: Bojana
authors.initials: B
authors.lastname: Grujić
keywords: Iatrogenic arteriovenous fistula; portal hypertension; superior mesenteric artery; variceal bleeding