2012 Volume 45 Issue 8 Pages 850-856
A 78-year-old woman underwent splenectomy under a diagnosis of intraabdominal bleeding caused by spontaneous rupture of a splenic cyst in September 2002. During the operation, splenic vessels were dissected by mass ligation of the artery and vein. About 4 years after the operation, the then asymptomatic patient was found to have dilatation of the splenic vein by abdominal US and was referred to our hospital in June 2006. Abdominal CT films showed a well-enhanced tumor, 7-cm with the same density as the splenic vein, located in the neighborhood of the pancreatic tail. Abdominal MRI films demonstrated that the tumor was markedly enhanced in the early phase and at the same time the slightly dilated portal vein was well-enhanced. Thus the tumor was diagnosed as arteriovenous fistula of the splenic vessels, and the operation was performed 3 years and 11 months after the previous splenectomy. Laparotomy showed the tumor had abundant pulsatile arterial blood flow, necessitating fistulectomy with ligation and resection of each splenic artery and vein. The Operative diagnosis was also splenic arteriovenous fistula, which was considered to have been derived from mass ligation of the splenic artery and vein. Cases of postsplenectomy arteriovenous fistula of the splenic vessels are very rare in Japan.
