Splenic Arteriovenous Fistula with Non-Cirrhotic Portal Hypertension : a Case Report
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 3, Pages 5380-5383
AbstractBackground:As an uncommon cause of portal hypertension, splenic arteriovenous fistula (SAVF) may show as stomach discomfort, diarrhea, ascites, and/or hematemesis. Formation of a fistula may be traumatic or spontaneous..[1,2]
Case Presentation : A 7 years old Female with history of recurrent episodes of hematemesis, endoscopy in 2021 showed tortous esophageal varices with multiple site of bleeding, Thoraco-abdominal CTA in 2021 showed thrombus in portal vein and Splenomegaly. During operation there was incidental finding of SAVF, the fistula then ligated and followed by retrograde thrombectomy portal vein and distal splenorenal shunt. Post operative abdominal ultrasound showed portal vein diameter 6mm with velocity 15.7cm/s, there was no recurrent hematemesis and patient was discharge on 7th day post operation.
Disscussion : Several misunderstandings regarding shunt surgery in the pediatric age range, such as increased failure rates in children less than 10 years, especially those with veins smaller than 10 mm in diameter. No long-term evidence exist to support these assumptions. Moreover, shunts are cost-effective, less distressing psychologically than recurrent endoscopic operations, and promote normal physical growth in youngsters. [4,5] Distal splenorenal shunt surgery provides a safe and reliable alternative to recurrent endoscopic operations for the avoidance of bleeding and improvement of hypersplenism in children with portal hypertension, according to a study published in the journal Pediatric Surgery.
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