-Case Reports-

Pancreatic Arteriovenous Malformation Involving Adjacent Duodenum with Gastrointestinal Bleeding: Report of a Case

Eiji Uchida¹, Takayuki Aimoto¹, Yoshiharu Nakamura¹, Akira Katsuno¹, Kazumitsu Chou¹, Masao Kawamoto¹, Shinpei Ono², Nobuaki Ishii³, Kazumasa Miyake², Shunji Fujimori², Choitsu Sakamoto² and Takashi Tajiri¹

¹Surgery for Organ Function and Biological Regulation, Nippon Medical School Graduate School of Medicine
²Department of Medicine, Nippon Medical School
³Department of Plastic Surgery, Nippon Medical School

A 54-year-old man was admitted to our hospital with the symptoms of palpitation, dyspnea, and tarry stool. Upper gastroduodenal endoscopy revealed submucosal lesions with vascular ectasia in the second part of the duodenum. Dynamic computed tomography (CT) detected a hypervascular lesion in the pancreatic head and the duodenum. Selective angiography showed proliferation of a vascular network and early filling of the portal vein at the early arterial phase. With a diagnosis of pancreatic arteriovenous malformation (AVM), we performed pylorus-preserving pancreaticoduodenectomy. At laparotomy, localized and meandering vessels were seen on the surface of the head of the pancreas. Histological examination showed dilated tortuous vessels accompanied by severed elastic fibers in the vessel media and blood clot formation. The incidence of pancreatic AVM remains extremely low, and recurrent gastrointestinal bleeding is a frequent complication. To prevent recurrent bleeding and progressive portal hypertension, surgery may be the definitive management of symptomatic AVM.

J Nippon Med Sch 2006; 73: 346-350

Keywords
pancreatic arteriovenous malformation, gastrointestinal bleeding

Correspondence to
Eiji Uchida, MD, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
uchida@nms.ac.jp

Received, September 14, 2006
Accepted, November 6, 2006