PMC10085540_01
Endoscopy and computed tomography angiography on admission and 2 months later. (A) Endoscopy on initial presentation showing large esophageal varices (blue arrow). (B) Computed tomography angiography on initial presentation showing splenic arteriovenous fistula (white arrow). (C) Percutaneous transcatheter embolization of the arteriovenous fistula and the pseudoaneurysm using 12-mm Amplatzer plug and coil. (D) Repeated endoscopy showing resolution of the esophageal varices after 2 months.
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Emergently, he underwent esophagogastroduodenoscopy (EGD) that showed large varices (>5 mm) in the middle and distal third of the esophagus and in the fundus of the stomach (IGV1) and changes suggestive of portal hypertensive gastropathy (Figure 1A). A subsequent CT angiogram of the abdomen and pelvis showed a fistulous communication between both the splenic artery and vein with pseudoaneurysm, moderate ascites, and diffuse colonic wall thickening with peritoneal stranding (Figure 1B). Later, he had successful percutaneous transcatheter embolization of both the arteriovenous fistula and the pseudo aneurysm by interventional radiology using a 12-mm Amplatzer plug and coil (Figure 1C). At follow-up 2 months later, EGD showed complete resolution of the esophageal and gastric varices with normal-appearing esophagus and fundus (Figure 1D).