Related Experiment Video
Updated: Apr 7, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Superior Mesenteric Arteriovenous Fistula Presenting with Massive Lethal Upper Gastrointestinal Bleeding 14 Years
Dušan Grujić1, Aleksandar Knežević1, Svetlana Vojvodić2
1Department of Internal Medicine, Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia.
Background:
Arteriovenous fistulas (AVFs) of the superior mesenteric vasculature are rarely encountered. We present a case of an iatrogenic superior mesenteric AVF in a patient who had undergone a small bowel resection 14 years previously.
Case Report:
The 45-year-old male was admitted with bloody diarrhea, fatigue, weight loss and moderate ascites. On the fifth hospital day, while being evaluated for suspected liver cirrhosis, the patient developed severe gastrointestinal (GI) bleeding. An upper GI endoscopy revealed bleeding, esophago-gastric varices. A thorough clinical examination pointed to a paraumbilical murmur and thrill, while a contrast enhanced computerized tomography (CT) scan of the abdomen revealed the presence of cystic dilatation of the superior mesenteric vein (SMV), hepatomegaly and ascites. Duplex ultrasonography and 3D-computed tomography angiography (3D-CTA) confirmed the existence of AVF between the superior mesenteric artery (SMA) and SMV, which was the cause of portal hypertension and variceal bleeding. Despite the fact that AVF was ultimately recognized, uncontrollable hypovolemic shock caused by hematemesis, precluded the probable efficiency of further therapeutic attempts.
Conclusion:
Successful management of mesenteric blood vessel AVFs involves timely and the accurate diagnosis and early treatment in order to prevent the development of life threatening complications.
Insights
This case report details a rare iatrogenic arteriovenous fistula (AVF) of the superior mesenteric artery and vein. Early diagnosis and treatment are crucial for managing these complex vascular abnormalities.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Interventional Radiology
Background:
- Arteriovenous fistulas (AVFs) in the superior mesenteric vasculature are uncommon.
- This report describes a rare case of an iatrogenic superior mesenteric AVF, occurring 14 years after a small bowel resection.
Purpose of the Study:
- To present a rare case of iatrogenic superior mesenteric AVF.
- To highlight the diagnostic challenges and potential complications of mesenteric AVFs.
Main Methods:
- A 45-year-old male presented with symptoms of gastrointestinal bleeding, ascites, and weight loss.
- Diagnostic workup included upper GI endoscopy, contrast-enhanced CT scan, duplex ultrasonography, and 3D-CTA.
- Imaging confirmed an AVF between the superior mesenteric artery (SMA) and superior mesenteric vein (SMV), leading to portal hypertension and variceal bleeding.
Main Results:
- The patient presented with severe gastrointestinal bleeding and esophago-gastric varices.
- Imaging revealed cystic dilatation of the SMV, hepatomegaly, ascites, and confirmed the SMA-SMV AVF.
- Despite diagnosis, uncontrollable hypovolemic shock prevented further therapeutic intervention.
Conclusions:
- Timely and accurate diagnosis of mesenteric blood vessel AVFs is essential.
- Early intervention is critical to prevent life-threatening complications associated with these vascular anomalies.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:24Esophageal Varices-I: Introduction
01:16Blood Supply to the Digestive System
Blood Supply to the Digestive System: The splanchnic circulation involves three main arteries: the celiac artery (also known as the celiac trunk) and the superior and inferior mesenteric...