Arteriovenous fistula of the splenic vessels (Hebrew)

A patient with recurrent bleeding esophageal varices of three years' duration was found at operation to have an arteriovenous (A-V) fistula of the splenic vessels which was resected together with the spleen. Rebleeding from a proximal remnant necessitated reoperation from which the patient recovered, and, when seen 10 mth later, was doing well. A-V fistula of the splenic vessels is very rare, only 54 cases have been reported, including one by the authors in 1971. The etiology may be congenital, aneurysmatic, mycotic, traumatic or iatrogenic. The main clinical sign is an arterial thrill or murmur. Splenoportography and selective celiac arteriography are the chief diagnostic measures. Surgical therapy is mandatory to prevent sudden life threatening hemorrhage.