[Arteriovenous fistula of splenic vessels after splenectomy]

Arteriovenous fistula of the splenic vessels is a rare complication of splenectomy since only 7 cases (including the case reported herein by the authors) are presently known. Simultaneous ligation of the vessels seems to be an important causative factor; enzymatic necrosis of the vessel walls due to a minute peroperative trauma to the pancreatic tail is also a plausible mechanism. All fistulas have been recognized within two years after splenectomy. Clinical findings consist of various signs among which a continuous left flank murmur is the most constant. Cardiac repercussions are usually lacking. The fistula induces hepatic lesions which never evolve towards hepatic sclerosis or cirrhosis and are reversible after closure of the arteriovenous communication. Portal hypertension is present only when associated hepatic lesions block the portal blood flow. Until recent years, surgical closure of the fistula was performed with satisfying results. Recently, non surgical closure has become possible and seems suitable in poor-risk patients.