Abstract
Arterio-venous fistulas may develop spontaneously, following trauma or infection, or be iatrogenic in nature. We present a rare case of a jejunal arterio- venous fistula in a 35-year-old man with a history of pancreatic head resection that had been performed two years previously because of chronic pancreatitis. The patient was admitted with acute upper abdominal pain, vomiting and an abdominal machinery-type bruit. The diagnosis of a jejunal arterio-venous fistula was established by MR imaging. Transfemoral angiography was performed to assess the possibility of catheter embolization. The angiographic study revealed a small aneurysm of the third jejunal artery, abnormal early filling of dilated jejunal veins and marked filling of the slightly dilated portal vein (13–14 mm). We considered the presence of segmental portal hypertension. The patient was treated with coil embolization in the same angiographic session. This case report demonstrates the importance of auscultation of the abdomen in the initial clinical examination. MR imaging and color Doppler ultrasound are excellent noninvasive tools in establishing the diagnosis. The role of interventional radiological techniques in the treatment of early portal hypertension secondary to jejunal arterio-venous fistula is discussed at a time when this condition is still asymptomatic. A review of the current literature is included.
Similar content being viewed by others
References
J Vauthey RJ Tomczak T Helmberger P Gertsch C Forsmark J Caridi A Reed MR Langham G Lauwers P Goffette J Lerut (1997) ArticleTitleThe arterioportal fistula syndrome: clinicopathologic features, diagnosis, and therapy 113 1390–1401
TD Boyer (1995) ArticleTitlePortal hypertensive haemorrhage: pathogenesis and risk factors Semin Gastrointest Dis 6 125–133 Occurrence Handle1:STN:280:BymD38vgvVM%3D Occurrence Handle7551969
CW Van Way MJ Crane DH Riddel JH Foster (1971) ArticleTitleArteriovenous fistula in the portal circulation Surgery 70 876–890 Occurrence Handle5124667
TD Boyer (1990) Portal hypertension and bleeding oesophageal varices D Zakim TD Boyer (Eds) Hepatology PA Saunders Philadelphia 572–615
JA Schilling FW McKee (1953) ArticleTitleLate follow-up on experimental hepatic-portal arteriovenous fistulae Surg Forum 4 392–397 Occurrence Handle1:STN:280:CyuC3cjltFM%3D Occurrence Handle13187306
GD Zuidema WD Gaisford MR Abell TM Brody Sa Neill CG Child (1963) ArticleTitleSegmental portal arterialization of canine liver Surgery 53 689–698 Occurrence Handle1:STN:280:CC2C1Mrps1E%3D Occurrence Handle14004067
PL Redmond DA Kumpe (1988) ArticleTitleEmbolisation of an intrahepatic arterioportal fistula: case report and review of the literature Cardiovasc Intervent Radiol 11 274–277
PD Orons AB Zajko CA Jungrels (1994) ArticleTitleArterioportal fistula causing portal hypertension and variceal bleeding: treatment with a detachable balloon J Vasc Interv Radiol 5 373–376 Occurrence Handle1:STN:280:ByuB2czhvFQ%3D Occurrence Handle8186610
J Bakker SG Robben FW Hazebroek M Meradji (1994) ArticleTitleCongenital arterioportal fistula of the liver with reversal of flow in the superior mesenteric vein Pediatr Radiol 24(3 198–199
DG Metzger (1972) ArticleTitleMesenteric arteriovenous fistula Am J Surg 124 767 Occurrence Handle10.1016/0002-9610(72)90135-3 Occurrence Handle1:STN:280:CSyD2cnhvFc%3D Occurrence Handle4539037
R Gartside RL Gamelli (1987) ArticleTitleSplenic arterio-venous fistula J Trauma 27 671–673 Occurrence Handle1:STN:280:BiiB2MvivFM%3D Occurrence Handle3599115
TE Gudmundsen M Lie H Ostensen (1988) ArticleTitleSplenic arterio-venous fistula. Case-report Acta Chir Scand 153 1313–1314
D Campbell JG Geragthy MM McNicholas JJ Murphy (1991) ArticleTitleDelayed presentation of traumatic splenic arterio-venous fistula Ir Med J 84 129–130 Occurrence Handle1:STN:280:By2B1czmtlA%3D Occurrence Handle1817121
Uflacker Renan, Selby J. Bayne, Chavin Kenneth, Rogers Jeffrey, Baliga Prabhakar (2002) Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation. Cardiovasc Intervent Radiol 6:300–306
DL Ridout SP Bralow A Chait M Nusbaum (1989) ArticleTitleHepatoportal fistula treated with detachable balloon embolotherapy Am J Gastroenterol 84 63–66 Occurrence Handle2912033
YN Applbaum JW Renner (1987) ArticleTitleSteel coil embolisation of hepatoportal fistulae Cardiovasc Intervent Radiol 10 75–79
P Ramchandani NJ Goldenberg RL Soulen RI White (1983) ArticleTitleIsobutyl 2-cyanoacrylate embolisation of hepatoportal fistula AJR 140 137–140 Occurrence Handle1:STN:280:BiyD1MjhsFA%3D Occurrence Handle6600302
GP Aithal BJ Alabdi JDG Rose OFW James M Hudson (1999) ArticleTitlePortal hypertension secondary to arterioportal fistula: two unusual cases Liver 19 343–347 Occurrence Handle1:STN:280:DyaK1Mzosleqsg%3D%3D Occurrence Handle10459634
Takuji Yamagami, Toshiyuki Nakamura, Tsunehiko Nishimura (2000) Portal hypertension secondary to spontaneous arterio-portal fistulas: transcatheter arterial embolisation with n-butyl cyanoacrylate and microcoils. Cardiovasc Intervent Radiol 23:400–402
Angle FJ, Matsumoto AH, McGraw KJ, Hagspiel KD, Spinosa DJ, McCullough CS (1999) Percutaneous embolisation of a high-flow pancreatic transplant arteriovenous fistula 22(2):147–149
CP Strassburg JS Bleck H Rosenthal (1996) ArticleTitleDiarrhoea, massive ascites, and portal hypertension: rare case of a splenic arterio-venous fistula Z Gastroenterol 34 243–244 Occurrence Handle1:STN:280:BymA3c%2FmsFA%3D Occurrence Handle8686353
Charles EK (2002) Portal hypertension: collaborative hypertext of Radiology Medical College of Wisconsin
BJ Phillips AJ Fabrega (2000) ArticleTitleEmbolisation of a mesenteric arteriovenous fistula following pancreatic allograft: the steal effect Transplantation 70(10 1529–1531 Occurrence Handle10.1097/00007890-200011270-00022
Toshiya Shibata, Tadashi Sagoh, Fumie Ametani, Yoji Maetani, Kyo Itoh, Junji Konishi (2002) Transcatheter microcoil embolotherapy for ruptured pseudoaneurysm following pancreatic and biliary surgery. Cardiovasc Intervent Radiol 25(3):180–185
L Defreyne I De Schrijver P Vanlangenhove M Kunnen (2002) ArticleTitleDetachable balloon embolisation of an aneurysmal gastroduodenal arterioportal fistula Eur Radiol 12(1 231–236 Occurrence Handle10.1007/s003300100935
RW Prokesch AA Bankier A Ba-Ssalamah W Schima TR Bader J Lammer (2001) ArticleTitleDisplacement of coils into the lung during embolotherapy: clinical importance and follow-up with helical CT Acad Radiol 8(6 501–508 Occurrence Handle10.1016/S1076-6332(03)80622-0
OF Hennessy RN Gibson DJ Allison (1986) ArticleTitleUse of giant steel coils in the therapeutic embolisation of a superior mesenteric artery-portal vein fistula CVIR 9 42–45 Occurrence Handle1:STN:280:BimB3Mjps1Y%3D
Peer A, Slutzki S, Witz E, Abrahmsohn R, Bogokowsky H, Leonov Y (1989) Transcatheter occlusion of inferior mesenteric arteriovenous fistula: a case report. 12:35–37
Author information
Authors and Affiliations
Corresponding author
Additional information
Fax 0041 31 6324874
Rights and permissions
About this article
Cite this article
Sonnenschein, M., Anderson, S., Lourens, S. et al. A Rare Case of Jejunal Arterio-Venous Fistula: Treatment with Superselective Catheter Embolization with a Tracker-18 Catheter and Microcoils. CVIR 27, 671–674 (2004). https://doi.org/10.1007/s00270-004-0101-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-004-0101-x