Portal hypertension secondary to splenic arteriovenous fistula

Abstract

Portal hypertension is a common condition in association with chronic liver disease; however, it is rarely caused by vascular shunting from splenic arteriovenous fistula (SAVF). We are presenting a case of non-cirrhotic portal hypertension due to SAVF. This condition is usually seen in multiparity women; however, other causes like trauma or mycotic infection are reported in the literatures with equal gender prevalence. Most of the patients present with gastric and esophageal varices, splenomegaly or upper abdominal pain. Clinical history and examination are the first step for diagnosis followed by ultrasound or contrast enhanced computer tomography. Splenic arteriovenous fistula must be then confirmed by selective celiac or splenic arteriography which is the gold standard tool. The condition is treatable either surgical ligation or intra-arterial embolization. Due to less invasive procedure, the later one is more favorable in unstable patients. Both procedures have been reported to be equally successful in managing SAVF.