Rectal arterio-portal fistula: An unusual cause of persistent bleeding per rectum following a proximal spleno-renal shunt

作     者：Hao Yun Yap Ser Yee Lee Yaw Fui Alexander Chung Kiang Hiong Tay Albert Su-Chong Low Choon Hua Thng Krishnakumar Madhavan 

作者机构：Department of General Surgery Singapore General Hospital Department of Surgical Oncology National Cancer Centre Singapore Department of Diagnostic Radiology Singapore General Hospital Department of Oncologic Imaging National Cancer Centre Singapore Department of General Surgery National University Hospital Singapore 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2013年第19卷第25期

页      面：4087-4090页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Portal hypertension Esophageal varices Splenorenal shunt Arteriovenous malformations Portal vein thrombosis 

摘      要：Gastrointestinal arterio-venous malformations are a known cause of gastrointestinal bleeding. We present a rare case of persistent rectal bleeding due to a rectal arterio-portal venous fistula in the setting of portal hypertension secondary to portal vein thrombosis. The portal hypertension was initially surgically treated with splenectomy and a proximal splenorenal shunt. However, rectal bleeding persisted even after surgery, presenting us with a diagnostic dilemma. The patient was re-evaluated with a computed tomography mesenteric angiogram which revealed a rectal arterio-portal fistula. Arterio-portal fistulas are a known but rare cause of portal hypertension, and possibly the underlying cause of continued rectal bleeding in this case. This was successfully treated using angiographic localizationand super-selective embolization of the rectal arterioportal venous fistula via the right internal iliac artery. The patient subsequently went on to have a full term pregnancy. Through this case report, we hope to high-light awareness of this unusual condition, discuss the diagnostic workup and our management approach.