Arterioportal fistula causing jejunal variceal hemorrhage

Hepatoportal arteriovenous fistulas are an uncommon cause of portal hypertension and may lead to severe gastrointestinal bleeding. Esophageal varices are the main source of hemorrhage in patients with portal hypertension. We report a 40-year-old man with a hepatic arterioportal fistula, who had gastrointestinal bleeding from jejunal varices. He had had hematemesis four years previously and was diagnosed as esophageal variceal bleeding secondary to hepatic arterioportal fistula-complicated portal hypertension. The fistula had been successfully closed with a detachable balloon but it was found to have reformed during his recent hospitalization for jejunal variceal bleeding. Alcoholism and development of portal vein thrombosis afterwards were the other contributing factors for jejunal variceal formation. Hemorrhage was controlled with medical treatment. Since he refused any surgical intervention he was discharged and advised to continue follow-up.