Coil embolization of symptomatic splenic arterioportal fistula following bariatric surgery

Arterioportal fistulae are abnormal communications between splanchnic arteries and portal veins and often lead to presinusoidal portal hypertension. Arterioportal fistulae may occur after bariatric surgery, posing significant clinical challenges due to potential complications like gastrointestinal bleeding. A 46-year-old woman underwent laparoscopic sleeve gastrectomy and presented 3 years later with abdominal pain and dark stool suspicious for bleeding. CT imaging demonstrated a splenic artery aneurysm with brisk arterioportal shunting and venous dilation. The patient underwent elective splenic artery embolization where microcoils were used to occlude 2 pseudoaneurysms, closing the arterioportal shunt. Follow-up imaging confirmed no further shunting and decrease in size of the splenic vein. Splenic arterioportal fistulae may occur after bariatric surgery and can lead to symptomatic portal hypertension. These fistulae are amenable to minimally invasive treatment with coil embolization.