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Title: Rectal arterio-portal fistula: An unusual cause of persistent bleeding per rectum following a proximal spleno-renal shunt
Authors: Yap, H.Y.
Lee, S.Y.
Chung, Y.F.A.
Tay, K.H. 
Low, A.S.-C.
Thng, C.H. 
Madhavan, K. 
Keywords: Arteriovenous malformations
Esophageal varices
Portal hypertension
Portal vein thrombosis
Splenorenal shunt
Issue Date: 7-Jul-2013
Citation: Yap, H.Y., Lee, S.Y., Chung, Y.F.A., Tay, K.H., Low, A.S.-C., Thng, C.H., Madhavan, K. (2013-07-07). Rectal arterio-portal fistula: An unusual cause of persistent bleeding per rectum following a proximal spleno-renal shunt. World Journal of Gastroenterology 19 (25) : 4087-4090. ScholarBank@NUS Repository.
Abstract: Gastrointestinal arterio-venous malformations are a known cause of gastrointestinal bleeding. We present a rare case of persistent rectal bleeding due to a rectal arterio-portal venous fistula in the setting of portal hypertension secondary to portal vein thrombosis. The portal hypertension was initially surgically treated with splenectomy and a proximal splenorenal shunt. However, rectal bleeding persisted even after surgery, presenting us with a diagnostic dilemma. The patient was re-evaluated with a computed tomography mesenteric angiogram which revealed a rectal arterio-portal fistula. Arterio-portal fistulas are a known but rare cause of portal hypertension, and possibly the underlying cause of continued rectal bleeding in this case. This was successfully treated using angiographic localization and super-selective embolization of the rectal arterioportal venous fistula via the right internal iliac artery. The patient subsequently went on to have a full term pregnancy. Through this case report, we hope to highlight awareness of this unusual condition, discuss the diagnostic workup and our management approach. © 2013 Baishideng. All rights reserved.
Source Title: World Journal of Gastroenterology
ISSN: 10079327
DOI: 10.3748/wjg.v19.i25.4087
Appears in Collections:Staff Publications

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