MESENTERIC ARTERIOVENOUS-FISTULA CAUSING PORTAL-HYPERTENSION AND BLEEDING DUODENAL VARICES

We report a case of portal hypertension associated with a non-traumati c arteriovenous fistula, presenting with bleeding duodenal varices. Th e patient was admitted for melaena. Emergency endoscopy showed oesopha geal varices with no signs of recent bleeding and with no blood in the upper gastrointestinal tract. Arteriography of the coeliac axis and s uperior mesenteric artery failed to detect any bleeding source. Endosc opy was repeated because of persistent bleeding and revealed active bl eeding from varices in the distal duodenum. The patient underwent surg ery and a large paraduodenal varicose vein associated with an arteriov enous fistula was found. Resection of the paramural varix and surgical occlusion of the arteriovenous fistula were effective in the control of bleeding. Liver biopsy revealed mild portal fibrosis without cirrho sis. Three years after surgery the patient still has oesophageal varic es but has not had recurrent bleeding. There was regression of intradu odenal varices.