Postgastrectomy Arteriovenous Fistula of the Gastroduodenal Vessels

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ARTERIOVENOUS fistulas occur as congenital lesions, as acquired lesions after penetrating injuries, as a result of the erosion of aneurysms into the accompanying vein, or as a complication of venipunctures or surgical procedures. A wide variety of the latter, from thyroidectomy to hysterectomy, have been reported to have resulted in arteriovenous fistula. So far as we can determine, however, there has been only one previous report of an arteriovenous fistula as a complication of gastrectomy: Reams1 described a fistula that developed between the middle colic artery and vein. The purpose of our paper is to report the development of a fistula, after gastric resection, between a branch of the gastroduodenal artery and vein, a fistula previously unreported as a complication of subtotal gastrectomy.

Report of a Case

A 48-year-old white man was admitted to the Cleveland Clinic Hospital on November 8, 1963. The patient had consulted his physician in March, 1963, because of an aching sensation in the right upper quadrant of the abdomen, and a murmur was heard in this area. In October, 1963, at another hospital, an intravenous aortogram revealed the presence of an abnormally dilated vessel in the region of the right renal artery. It was believed that this represented a fistula between one of the renal arteries and the renal vein. Significant in the patient's history was the fact that in June, I960, he had undergone a subtotal gastric resection with gastrojejunal anastomosis, for two gastric ulcers.

On physical examination, the patient's temperature was normal; his . . .



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