Arteriovenous fistula and portal hypertension secondary to islet-cell tumor of the pancreas.

A case of portal hypertension secondary to an arteriovenous fistula in a pancreatic tumor is presented. Recurrent gastrointestinal hemorrhage prompted endoscopy which revealed esophageal varices and an abnormal papilla of Vater. Ultrasonography and arteriography were instrumental in demonstrating the nature of the pathological process. In this situation portal hypertension resulted from increased portal venous flow rather than portal obstruction. Correction must include obliteration of systemic arterial to portal venous communication.