Arterioportal fistula after partial gastrectomy treated with coil embolisation

Abstract

Arterioportal fistulas are a rare complication of abdominal interventions. They can remain asymptomatic for a long time and manifest with symptoms of portal hypertension. We present the case of a 65-year-old man admitted to the emergency room with increasing fatigue and melena. He had a history of partial gastrectomy with Billroth II reconstruction 40 years earlier for peptic ulcer perforation. On physical examination, he was pale and presented a machinery-type murmur in the epigastric area. Blood tests revealed iron deficiency anaemia of 5.6 g/dL. During hospitalisation, he required several blood transfusions and maintained melenas. An abdominal CT angiography showed a fusiform aneurysm of the left gastric artery draining to the venous portal-splenic confluent. He was successfully treated with transarterial coil embolisation of the left gastric artery aneurysm. The correct diagnosis of arterioportal fistulas can be very challenging, whereas the standard treatment with coil embolisation offers a low morbidity resolution of symptoms.

A case of ascites and SMV thrombosis dueto an intrahepatic arterio-portal fistula after hepatectomy

“…While the development of APFs immediately after trauma has been described, one case of intrahepatic APF was diagnosed 2.5 years after hepatic injury. A review of other reports also revealed that some described APFs becoming symptomatic soon after the causative event(s) 3,9) , while others suggested that APF could gradually exacerbate 2,6,11,12) . Reportedly, APFs have been diagnosed 18-20 years after the causative event 10,11) .…”

“…Arterio-portal fistula (APF) describes an abnormal communication between artery and portal vein 1) , which can arise due to hepatic injury 1,2) , ablation therapy for tumors 3,4) , liver biopsies 5) , and surgeries 6) in adults. Although the entity is well-known, its incidence is rare.…”

“…After hepatectomy, only a small number of cases were described in literature 7,8) , with the incidence remaining unknown except that it is extremely rare. Clinical features and treatments vary among individuals, ranging from asymptomatic small fistulas that spontaneously resolve to severe symptoms derived from portal hypertension and necessitating urgent treatment [1][2][3][4][5][6] .…”

Coil embolization of asymptomatic left gastric artery aneurysm: Case report and literature review

“…antitrypsin deficiency, 9 one case of IgG4-related multiple coronary aneurysms, 10 one with the tumor communicating with portal vein to form portal vein fistula. 11 Treatments employed included endovascular therapy (n = 28, 59.6%), open surgical treatment (n = 8, 17.0%), and laparoscopic surgery (n = 2, 4.3%). There was one case where the patient received open surgery for Type II endoleak and hemorrhage after coil embolization.…”

“…Other clinical features included nausea, vomiting, hematemesis, tarry stools, abdominal dropsy, anemia, hemothorax, and posterior mediastinal hematoma. Among those cases, seven patients, accompanied by pancreatitis, had complicated symptoms, 3–7 one with Marfan syndrome 8 (there was another one with systemic connective tissue disease, undiagnosed), one with α‐1 antitrypsin deficiency, 9 one case of IgG4‐related multiple coronary aneurysms, 10 one with the tumor communicating with portal vein to form portal vein fistula 11 . Treatments employed included endovascular therapy ( n = 28, 59.6%), open surgical treatment ( n = 8, 17.0%), and laparoscopic surgery ( n = 2, 4.3%).…”