Staten Island University Hospital Staten Island, NY, United States
Ahmad Abou Yassine, MD1, Hassan Al Moussawi, MBBS1, Mohammad Abureesh, MD1, Loai Dahabra, MD1, Mohammad Alshami, MD1, Sanjaya Satapathy, MD2 1Staten Island University Hospital, Staten Island, NY; 2North Shore-LIJ Health System, Manhasset, NY
Introduction: Non-cirrhotic portal hypertension (NCPH) is a rare disease characterized by portal hypertension in the absence of cirrhosis or other causes of liver disease and splanchnic venous thrombosis. Etiologies include immunological disorders, chronic infections, exposure to medications or toxins, genetic disorders, and prothrombotic conditions. In this case, we present a rare delayed presentation of NCPH due to remote traumatic arteriovenous fistula.
Case Description/Methods: 54-year-old male with a past medical history of psoriasis, ulcerative colitis, and remote traumatic abdominal stab injury presented with a 1-day history of hematemesis, 4 days of loose tarry stools, and 6 months of increase abdominal distention and decrease appetite.
He denies any history of NSAID, steroid or alcohol use, or any history of PUD. His workup was negative for any chronic liver disease. EGD revealed large varices in the middle and distal third of the esophagus and the fundus of the stomach . 4 bands ligation were successfully applied in esophagus. His CTA abdomen and pelvis confirmed a fistulous communication between both the splenic artery and vein with pseudoaneurysm, moderate ascites and diffuse colonic wall thickening with peritoneal stranding. No radiologic evidence of liver cirrhosis or portal/hepatic vein thrombosis was seen. Later, successful coil embolization of both the AV fistula and the pseudoaneurysm was done. He was observed for 2 days in hospital then discharged safely home. After 2 months, a follow-up EGD showed complete resolution of esophageal and gastric varices with normal appearance of mucosa in esophagus and fundus.
Discussion: After abdominal trauma, splenic AVF is a very rare entity that may be asymptomatic for a long time. However, some of them presents with delayed complications including portal venous hypertension with ascites, hepatoportal sclerosis and upper and lower gastrointestinal hemorrhage. Diarrhea and chronic abdominal pain from bowel ischemia due to mesenteric steal syndrome have also been described in literature. In this case, the patient had a remote exploratory laparotomy secondary to stab wound 15 years ago, with a formation of arteriovenous fistula leading to delayed presentation of portal hypertension. Interestingly, a complete resolution of his portal hypertension was seen after coil embolization.
Figure: Figure 1: esophageal varices at presentation Figure 2: Fundic varices at presentation Figure 3: AVF pre and post embolization Figure 4: lower esophagus 2 months later
Ahmad Abou Yassine indicated no relevant financial relationships.
Hassan Al Moussawi indicated no relevant financial relationships.
Mohammad Abureesh indicated no relevant financial relationships.
Loai Dahabra indicated no relevant financial relationships.
Mohammad Alshami indicated no relevant financial relationships.
Sanjaya Satapathy indicated no relevant financial relationships.
Ahmad Abou Yassine, MD1, Hassan Al Moussawi, MBBS1, Mohammad Abureesh, MD1, Loai Dahabra, MD1, Mohammad Alshami, MD1, Sanjaya Satapathy, MD2. P1548 - Splenic Arterio-Venous Fistula Leading to Non-Cirrhotic Portal Hypertension: A Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.