Portal hypertension resulting from splenic arteriovenous fistulae.

Portal hypertension is commonly due to obstruction to portal blood flow either within the liver as in cirrhosis, or within the portal vein, as from thrombosis. In recent years, however, reports have multiplied of portal hypertension in the absence of both intrahepatic and extrahepatic obstruction (Rousselot, 1940; Whipple, 1945; Hallenbeck and Shocket, 1957; Tisdale, Klatstin, and Glenn, 1959; Leather, 1961; Imanaga,Yamamoto, and Kuroyanagi 1962; Polish, Christie, Cohen, and Sullivan, 1962; Valdoni, 1963; Siderys and Vellios, 1964; Turnberg, 1964), and interest has been directed to other ways in which portal hypertension might be brought about. Shunts between the portal-venous and the arterial systems have been postulated in some such cases but rarely demonstrated. The following three cases show that such shunts in the portal-venous bed may cause all the phenomena of portal hypertension or may have only limited manifestations. Fistulae between the splenic artery and vein were found in the splenic pedicles in all three cases and oesophageal varices were demonstrated in two of them.