Arteriovenous fistulas after gastrectomy: case report and review of the literature.

Mesenteric-portal arteriovenous fistula is an uncommon complication of gastrectomy. Management of a patient with this entity stimulated a comprehensive review of the 18 previously reported cases in the world literature. While presenting symptoms vary, physical findings are characteristic and include abdominal murmur (100% of patients) and palpable thrill (47%). Arteriography is essential to document mesenteric vascular anatomy. The most common arteries involved are the gastroduodenal and the right gastroepiploic (63%). Absence of portal hypertension is attributed to a normal liver, small-caliber fistulous communication, and normal portal venous compliance. Operative treatment in all reported cases has proved successful and is indicated to alleviate symptoms and prevent fistula rupture.