Gastroduodenal arterioportal fistula: Two case reports and review of literature

Figure 1 Case 1 angiography and embolization therapy. A: Preoperative celiac trunk angiography showing the gastroduodenal artery (orange arrow) and the saccular aneurysm cavity at the fistula (blue arrow); B: Coil embolization of the distal feeding artery (blue arrow), the draining vein of the fistula (orange arrow), and the proximal feeding artery (black arrow); C: Follow-up angiography revealed no opacification of the arterioportal fistula (orange arrow).

Figure 2 Case 2 preoperative imaging and angiography. A: Magnetic resonance cholangiopancreatography showing a 21 mm × 14 mm T1-hypointense lesion in the pancreatic head; B: Esophagogastroduodenoscopy revealed fresh blood adherent to the mucosa at the junction of the duodenal bulb and descending duodenum, without an identifiable ulcer or neoplastic lesion; C: Endoscopic ultrasonography demonstrating a well-defined hypoechoic mass in the uncinate process with prominent peripheral blood flow on color Doppler; D: Arteriography demonstrating the abnormal vascular network in the descending gastroduodenal artery (blue arrow) and the gastroduodenal artery (orange arrow).

Figure 3 Case 2 histopathology. A: Endoscopic ultrasonography-fine-needle aspiration aspirate showing only hemorrhagic and fibrinous tissue (non-diagnostic); B: Histopathological examination of the lesion revealing numerous malformed arteriovenous vessels within pancreatic tissue.

Figure 4 Case 2 follow-up contrast-enhanced computed tomography. A: Axial image at 12 months; B: Axial image at 24 months. Both demonstrate expected postoperative changes and mild dilatation of the main pancreatic duct.