Arteriovenous fistula of the splenic vessels producing ascites.

T HE opportunity to cure ascites is a gratifying clinical experience but is seldom encountered. Recently we have observed and successfully treated a patientt with as(ites and an arteriovenous fistula of the spleniic artery and vein. Arteriovenous fistulas may occur wherever arteries and veins lie in proximity. The usual clinical maanifestations, such as thrill, machinery murmur, increased venous pressure with its sequelae in the involved region, and at times cardiac enlargement and failure, are well known. An arteriovenous communication between a systemic artery and the portal vein or one of its tributaries quite logically might produce portal hypertension and its sequelae. Sigwartl reviewed the literature prior to 1953 and found 3 cases2-4 of splenic arteriovenous fistula reported in detail and another5 memstioned, and he added 1. In 1935 Stener6 reported a case. Of these, only 1, the patient of Goodhart,3 had ascites, while 4 patients piesented with repeated gastrointestinal bleeding from esophageal varices.1' 3 4, 6 Two instances of hepatoportal arteriovenous fistula have been reported7' and 1 of these patients had ascites.7