A Rare Case of Superior Mesenteric Arterio-venous Fistula Causing Jejunal Varices and Recurrent GI Bleeding

Superior mesenteric arterio-venous (SMA-V) fistulas are rare. They are usually associated with penetrating abdominal trauma or gastrointestinal surgery. We report a patient, who presented with recurrent mild gastrointestinal bleeding and severe abdominal distension for 3 months after a small bowel resection for acute abdomen. A machinery-type bruit was audible in the epigastrium. Oesophageal varices were seen on a gastroscopy. A SMA-V fistula was diagnosed on an angiogram after a large mesenteric vein was seen on CT. The patient had a successful laparotomy with ligation of feeding artery and surgical resection of involved small bowel. A literature review of SMA-V fistulas is discussed.

Keywords: Superior mesenteric arterio-venous fistula, Portal hypertension

Abbreviations: PV, Portal vein, SMV, Superior mesenteric vein, SMA, Superior mesenteric artery, CT, Celiac trunk