Portal arteriovenous fistula following partial gastrectomy

An emergency transthoracic transection of the esophagus was performed on a 62 year old man for hematemesis caused by rupture of esophageal varices. Hepatic functional reserve of this patient was classified as Child C. Postoperative celiac arteriography revealed an arteriovenous fistula between a branch of the gastroduodenal artery and a branch of the superior mesenteric vein. He had undergone a partial gastrectomy with Billroth II reconstruction 15 years earlier. Bleeding from the esophageal varices did not recur, but he subsequently died of liver failure. In some areas of the liver the microscopic changes were similar to those occurring in cirrhosis, but in most areas they resembled those seen in congestive liver fibrosis. This case suggested that portal arteriovenous fistula is an important predisposing cause leading to deterioration of liver function.