Ibrahim Haddad, MD1, Bara El Kurdi, MD1, Sumbal Babar, MBBS1, Mohammad Alomari, MD2, Mahmoud El Iskandarani, MD1, Mark Young, MD1
1East Tennessee State University, Johnson City, TN; 2Cleveland Clinic Foundation, Cleveland, OH
Introduction: Arteriovenous fistula of the superior mesenteric vasculature is a rare entity that was reported for this first time by Movitz and Finne in 1960. The majority of these cases are iatrogenic after surgical bowel resection. We present a 52-year-old male patient who had a spontaneous AFV of the superior mesenteric vasculature that presented as a chronic portal vein thrombosis.
Case Description/Methods: A 52-year-old male patient with a past medical history significant for active hepatitis C infection. The patient presented to our institution complaining of progressive abdominal distention and chronic abdominal pain for 3 months. He had been diagnosed with cirrhosis two months prior to admission and was started on furosemide and spironolactone for ascites and underwent multiple therapeutic paracentesis. At presentation, the patient was found to have a normal platelet count and INR which were not consistent with cirrhosis calling the diagnosis into question. Further workup with ultrasound examination of the liver revealed portal vein thrombosis with extension to the proximal part of the splenic vein. This was followed by CT of the abdomen and pelvis with IV contrast which showed smooth liver surface, enlarged portal, superior and inferior mesenteric veins with clot seen in the left portal vein extending into the main portal vein(Figure 1).it also showed a fistula of the mid superior mesenteric artery with the superior mesenteric vein (Figure 2) which explained the prominence and the enlargement of the portal venous system. Upon diagnosis, the patient was transferred to a tertiary center for endovascular closure of the fistula.
Discussion: Arteriovenous fistula of the superior mesenteric vasculature is a rare entity. Most cases are iatrogenic in origin occurring after bowel resection. The most common presentation is gastrointestinal bleeding due to portal hypertension and resulting variceal changes. Treatment with endovascular with coil embolization is often preferred over surgical repair. In summary, we discuss an unusual presentation of idiopathic arteriovenous fistula of the superior mesenteric vasculature with portal vein thrombosis, abdominal pain and ascites mimicking hepatic cirrhosis with spontaneous bacterial peritonitis.
Citation: Ibrahim Haddad, MD; Bara El Kurdi, MD; Sumbal Babar, MBBS; Mohammad Alomari, MD; Mahmoud El Iskandarani, MD; Mark Young, MD. P0416 - SUPERIOR MESENTERIC ARTERIOVENOUS FISTULA MIMICKING HEPATIC CIRRHOSIS WITH SPONTANEOUS BACTERIAL PERITONITIS. Program No. P0416. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.