A rare case of gastric varices and splenic artery aneurysm secondary to splenic arteriovenous fistula

Abstract

A 33-year-old male with no past medical history presented with a few months of fatigue and reduced exercise tolerance and was found to have iron-deficiency anemia. An esophagogastroduodenoscopy revealed a cluster of isolated gastric fundal varices with high-risk stigmata. Serologic workup for cirrhosis was negative, and a FibroScan measured liver stiffness at 4.2 kilopascals. Computed tomography (CT) of his abdomen and pelvis showed non-cirrhotic portal hypertension, as well as the presence of a splenic arteriovenous (AV) fistula and splenic artery aneurysm (SAA). Resection of the fistula, SAA, and spleen completely resolved the gastric varices and anemia.

Etiologies of Splenic Venous Hypertension: A Review

“…Several case reports have also been published (Tables 1A and 2A). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Lymphoma: Case reports described compression of the SV by lymphoma, presenting with variceal bleeding, absence of cirrhosis, and imaging and pathology indicative of lymphoma. In one case, high-grade-B-cell lymphoma resolved gastric varices with chemotherapy alone, while a case of large B-cell lymphoma required splenic artery embolization and chemotherapy for resolution (Tables 1A and 2A).…”

“…On follow-up, one case had a resolution of gastric varices (Tables 1A and 2A). 15,16 Bochdalek hernia: Bochdalek hernias are congenital diaphragmatic hernias resulting from a failed closure of the posterolateral diaphragm. 17,18 They present in adults with an incidence of 0.17%.…”

“…18 Splenectomy and aneurysmectomy have been suggested for SAAs. 15,16,69 Studies on aneurysmectomy alone have not been reported.…”